Single Anastomosis Duodeno-ileal Bypass

I went for my initial consultation last week with all intentions of having the sleeve gastrectomy.  My doctor is wonderful at explaining all the options, risks, expected outcomes, etc.  He explained that given my BMI (56.5) and based on 20 years worth of data, I could expect to lose around 125lbs.  Unfortunately for me, this would still leave me with a BMI above 40...in other words, I'd likely still be morbidly obese after the sleeve.  Based on the numbers, I could expect to end up around 235lb and my goal is to get down to around 180.  

He offered me the option of having the Sleeve Gastrectomy with Single Anastomosis Duodeno-ileal Bypass (SIPS).  I believe it is sometimes referred to as SADI-S or loop DS.  He wasn't trying to sell me on it, but in his opinion, someone with a BMI as high as mine could possibly reap great benefits by adding the malabsorption component to the sleeve.  He did explain that this was a relatively new procedure in the US and that so far, the data has shown increased weight loss above the sleeve alone with less risk than a traditional DS or RNY.  It is hard to find a lot of info this procedure, but based on what I have read, I am leaning towards having it.  Has anyone had this procedure?  If so, I'd like to ask you some questions, especially if you are a year or more post-op.  Thanks!

I have nothing to add about the surgery but I applaud the explanation your surgeon gave you about the use of this procedure. We have ahd some people that were pointed to the procedure without the benefit of knowing that there wasn't much data out there on the procedure. Hopefully, you will find some of the info you are looking for.

Your surgeon is right that the sleeve is probably not going to get you where you need to be with weight loss.  The DS would be a great benefit for you, and has the statistics to back up your chances for success.  

This SADI is a brand new procedure that a few surgeons have started doing.  It may be what you need, it may not be.  There haven't been enough patients yet to determine its success rate, short or long-term.  It's one of those things that "looks good on paper" and they are hoping for the best.  Everything starts this way, and it takes time and brave souls like you to consider making a leap of faith.  A couple of things to keep in mind about it.

1. Insurance will not cover this surgery or likely any associated complications down the road as a result of it.
2. Since there are only a few docs doing this procedure, if your doc moves, retires, etc., it could be extremely difficult to find a surgeon to help you if you should develop any complications or need any revision down the road.  Many surgeons won't work on another surgeon's patient, ESPECIALLY on an experimental procedure.

I contacted my surgeon's office and they informed me that the procedure is covered by my insurance.  They gave me the CPT codes but that really doesn't mean much to me.  I would still like to ask a few questions of anyone who has had this procedure.

What is the CPT code, if you don't mind sharing?

CPT 43775 for the sleeve and CPT 41330 for the anastomosis of the intestine.

Not sure what they mean.  I googled them and really didn't find anything.

I used Google to find places where you can look up CPT codes. 41330 keeps coming up as non-existant.

Okay, so they are splitting the surgery into two different procedures to code for, which puts my hinkey-meter up.  Out of curiosity, I would ask the insurance company yourself if they cover the SADI-S as a wls procedure.  You just want to make absolutely sure they are on the up-and-up about this.  If the insurance company smells fraud, they could hold you accountable for the charges.

After doing some research, the reason for the two codes is that the insurance company does not have a specific code for this procedure.  So, the Dr has to use what is called an unlisted code to bill for the second part of the operation.  There are lots of unlisted codes used for all kinds of procedures.  When a Dr submits a request for approval with an unlisted code, it goes for medical review with the insurance company.  As such, the request is subject to more scrutiny than when a request is made using a listed cpt code.  My understanding is that my particular insurance company does in fact approve this procedure with these codes and has done so for a number of patients.  As the procedure becomes more mainstream, I am sure it will receive a specific listed cpt code.  This should lay to rest the fraud argument.  I would think in order for this procedure to be considered fraud, the surgeon would have to bill for another procedure (BPD-DS) while performing this one.  Clearly, that is not the case.  

I was given the single loop when what I wanted was the full. I had lost 100# with the sleeve but needed to lose more. I only lost 12 # after the single loop!but it does help me with not gaining in maintenance. 

I have the same bowel issues as DSers but it is very manageable unless I eat carbs/sugar,then I have stinky gas and poop. 

It might do better for someone who has more to. Lose to begging with,but I don't know.