Sadi vs gastric bypass

[Suzytoronto 11]

I'm being offered both options but my surgeon is recommending sadi over gastric bypass because my BMI is 60 I'm so confused any help? Thanks

[ChunkCat 729]

The SADI and the Duodenal Switch (they are different) are the two surgeries with the highest percentage of excess weight loss, the lowest rate of regain and the best reputation for significant weight loss in people with high BMIs. You can read studies about this. That said there are plenty of people with high BMIs that go with Gastric Bypass instead and plenty of them do keep the weight off.

Both surgeries have restrictive and malabsorptive components, though their malabsorption is rather different. The bypass tends to be better for people with GERD issues but has a higher risk of ulcers and strictures. The SADI-S tends to be better for people at risk of developing ulcers, for those that smoke or vape and plan on going back to it after surgery healing is complete, and for those that may need to take NSAIDS in the future.

The bypass involves a modified stomach with smaller capacity (about that of an egg) while the SADI has a sleeve stomach (banana shaped) so will eat bigger portions. Both still restrict enough calories for weight loss. The SADI is pylorus sparing so the stomach still has the valve in it that keeps food in so digestion happens in a more normal way, the bypass has no pyloric valve so you have to be extra mindful to chew thoroughly as things pass through the stomach differently.

Both have to supplement Vitamins but do so in a different way--but they are not optional. If you stop taking the vitamins you run a high risk of nutritional deficiencies.

The diets are a bit different for the two. I believe bypass patients need to be mindful of seeds, skins, and meat that is overly dry. They need to be more particular with lean Protein as they don't have malabsorption of fats to the same degree a SADI patient will. There is some conflicting data that suggests fat absorption in SADI-S patients normalize in the second year post surgery so they need to be careful about not eating too much fat, but the studies are by no means conclusive at this point. SADI patients need a bit more protein than bypass patients since the SADI bypasses a larger amount of the small intestine.

Dumping syndrome is more common with bypass. Diarrhea may be more common with SADI-S though I've been told most tend towards Constipation like with the bypass. SADI people may have more gut issues with carb consumption but don't tend to have dumping syndrome.

SADI-S is a much newer procedure and we don't know as much about it as the bypass. That doesn't mean it is bad and it isn't considered experimental by many insurances anymore, but the fact remains we still don't understand as much about it as we do the Gastric Bypass or Duodenal Switch.

In the end it is very much a matter of preference and which patient profile you fit best. You have to pick the surgery that works best for you! I wish you much luck in deciding, I'm debating the sleeve vs DS myself.

ETA: The SADI has a bit better chance of resolving metabolic conditions like diabetes and other co-morbidities. Though the bypass does a good job of resolving those too compared to the sleeve!

Edited August 16, 2023 by ChunkCat

[Suzytoronto 11]

Thank you so much for your reply. I feel like you answered all my questions.

You have been such a big help to me ❤️

[catwoman7 11,214]

a couple of corrections and comments on bypass. Strictures only happen to about 5% of bypass patients and they're very easy to fix (I had two of them). If they happen, it'll be during the first three months after surgery. They almost never occur after that.

there are no food restrictions with bypass after about the first six months. Zero. fruit with seeds and/or skins, dry meat, etc - all fine. Those are only restricted during the first few weeks or months after surgery.

[catwoman7 11,214]

another comment re: dumping. About 30% of bypassers dump. I never have, and I know plenty of others who don't, but about 30% do. It's caused by eating too much sugar or fat at one sitting - so the way to control it is to, of course, limit the amount of sugar or fat you have at one sitting (which we should be doing regardless, even if we don't dump!)

I don't know much about SADI so I can't really comment on it, although generally speaking, the more powerful the surgery, the higher the risk of complications. But that being said, none of these surgeries have a particularly high risk of complications - and most are minor and preventable (or "fixable", like strictures)

I lost over 200 lbs with my bypass, so it can be done - but the average person tends to lose more weight with the DS (not sure about SADI, again, I'm not familiar with it, but since it's a modified DS, and given your surgeon's comment, I'm assuming that's true of the SADI, too).

[catwoman7 11,214]

oh - and yes - ChunkCat is correct - bypass is more effective at resolving metabolic issues than sleeve. I don't know how SADI does with this - SADI wasn't done when I had my surgery, so I didn't research it.

[Suzytoronto 11]

Thank you cat woman diid you find it hard to lose the 200lbs? I'm worried I'm.going to be weak and sick looking.

Edited August 16, 2023 by Suzytoronto

[catwoman7 11,214]

honestly, there are more people who never make it all the way to their goal than there are those who lose too much, but that said, you can always increase your calories to either stop your weight loss or gain a few pounds if you think you're getting too thin. So I wouldn't worry about that at all.

I lost 100% of my excess weight and yes, for a time I was "too thin", but I was also aware that a majority of us have a 10-20 lb rebound weight gain during year 3. And I did. In addition, even before the rebound gain, things (fat, I guess?) tends to re-distribute itself after a big loss, so even though I weighed the same for awhile, I started looking a lot better. My face filled out, etc - even before that gain.

as far as it being hard - the first year, it wasn't too bad - esp before my hunger and appetite came back at month 5. For those first few months, for the first time in my life, I wasn't thinking about food at all the time. In fact, I didn't think about it much at all - and at times didn't even want any. Even though it was weird not to ever be hungry and to not give a flip about food, I found it very liberating! But things changed at month 5 when suddenly my hunger came back (and it does for most of us sometime during the first year). Then you're dealing with the hunger beast again, although it's not as strong as it was before surgery. But I wanted more than anything to lose this weight once and for all, so I really stuck to my program and lost it all (weight loss didn't stop until I was almost two years out, though - I had A LOT to lose!)

it does get harder after the first year because diet fatigue sets in, as well as some old habits. You really, really have to watch yourself. And eight years out, I have to continue to watch myself. It's so easy to slip into old habits. But I have a "drop dead weight" limit - I weigh myself once a week now, and if I hit that limit - or come close to it - I cut back until my weight is safely within the limit again. But this really isn't any different from most of my never-been-obese friends. So many of us have to monitor our weight and to cut back when it starts getting too high.

anyway, yes, it can be hard - esp when your hunger comes back and your motivation starts to wane, but unlike before, your effort actually pays off. You put in the work, and the weight comes off (or stays off). Before, the most I could ever lose is about 50 lbs (and even that was rare - most of my dieting ended up with a 10 or 20 lb loss). And inevitably, it will all come back. Happened every time. BUt this time, it worked!

[Suzytoronto 11]

Congratulations cat woman I can't wait to be where you are now

[The Greater Fool 2,039]

Back when I had surgery SADI wasn't really a thing yet so I never researched it. Of course, neither was VSG. My research lead me to ultimately choose RNY. Because of my size it was an open surgery which made early recovery very painful.

I'm one of the lucky ones that dump both on sugars and fats. Back when I had surgery it was more of a 50/50 chance I would dump. I hoped I would dump so that I'd have another tool to keep me from the wrong foods. It took an amazingly few dumping episodes to learn to avoid sugars and fats. All these years later it's all just part of the joy of being me.

I managed to lose my excess weight, a bit over 500 pounds, and keep it off. It's now pretty natural eating to my surgeon's program, I don't really even think about it. It's all just normal.

There are success stories with virtually every type of surgery. Build good habits during the honeymoon phase and they will serve you when your surgery is but a distant memory.

Good luck,

Tek

[Suzytoronto 11]

Wow 500lbs that's amazing congratulations. I just had open surgery in 2021 C section and it was horrible because of my weight

[ChunkCat 729]

12 hours ago, catwoman7 said:

there are no food restrictions with bypass after about the first six months. Zero. fruit with seeds and/or skins, dry meat, etc - all fine. Those are only restricted during the first few weeks or months after surgery.

It's nice to know not everyone has to avoid those things long term with the RNY. I was going by what I've read and heard from other RNY patients I've met, many of whom still avoid those things, especially dry meat. I suppose it is one of those things where there are a variety of experiences due to individual needs and the variety of plans from doctors and dietitians.

I could have included the statistics for everything but it would have been a much longer post and probably a bit overwhelming to read. I find when comparing features of surgery that statistics don't matter to me much, a chance of something is a chance of something and still goes into my weighing and balancing of the surgeries overall, but I'm sure everyone differs on that.

My goal was to write a post that was easy to understand and fairly neutral, as I've noticed most surgery patients are heavily biased to their own surgeries unless they are experiencing complications and have plans of revision. We have a lot of bypass patients on this board so I figured you guys would chime in. Sadly we don't have many that have had the SADI or the DS, which is unfortunate because these are really great surgeries for the right person.

Thanks for chiming in with your experience Catwoman7, your weight loss and maintenance is truly impressive and you always add great things to a discussion!

Edited August 16, 2023 by ChunkCat

[catwoman7 11,214]

22 hours ago, ChunkCat said:

It's nice to know not everyone has to avoid those things long term with the RNY. I was going by what I've read and heard from other RNY patients I've met, many of whom still avoid those things, especially dry meat. I suppose it is one of those things where there are a variety of experiences due to individual needs and the variety of plans from doctors and dietitians.

there are definitely people who continue to be intolerant of certain items even months or years out - and/or people who continue to avoid things like Pasta and rice because those can sit like a brick in some people's stomachs = and people who have to limit fat or sugar because of dumping or RH - but as far as having restrictions dictated by their clinics, I'm not aware of anyone who still has them once they're a few months out, but then, I haven't taken a survey or anything, so you may be right. We had none once we reached the six-month mark.