SIPS

jaljure74
on 6/13/17 10:43 am

Has anyone here has had the SIPS surgery?? What are the Pros' and Con's ? I am thinking of having this done I am a previous gastric sleeve patient my pouch has stretched and looking to have something else done.

Amy R.
on 6/17/17 12:48 am

Is this the "smaller, safer" DS?

There is a lady here who is thinking on getting the SADI done (I don't know if that's the same thing as the SIPS though). She has a lot of information and is actually putting together some models to study patterns that occur after surgery.

Her name is Donna. I'll go give a nudge to come on over. She knows SO much about all this. Hold on. =)

Donna L.
on 6/19/17 8:35 am, edited 6/19/17 1:36 am - Chicago, IL
Revision on 02/19/18

Hey there:)

I am contemplating the SIPS/SADI or the DS. There are a few pros and cons. Before making a decision, I would speak to DS patients, of whom the forums have many knowledgeable ones.

In the end, they are fairly equivalent at this time, with the DS being very slightly better.

Thing is, the DS is far more rigorously studied and has the best outcomes with a very high BMI. It is the gold standard for severe morbid obesity. If you want a surgery that is tested and well-validated, the DS comes lightyears ahead of the SADI.

The SIPS/SADI is relatively new. It's been done about 10-11 years, and we are now seeing 10 year data on it, though some is not yet published. No surgeon is very experienced with this procedure in the US to the same degree that they are experienced with the DS. There are DS surgeons (Prachand and Dr K come to mind) who have done probably thousands of procedures at this point. This means they are highly skilled and the complication rates are very low. It also means you are getting a surgery with a known result.

The SADI has promising numbers so far. The issue is more that we do not know the longevity of results, or the long-term data. So far the numbers look good. I expect this will replace the RNY eventually, rather than replacing the DS, due to the longevity. It still requires rigorous supplementation like the DS, though, and in much the same way. You also malabsorb less calories, particularly less fat. The DS malabsorbs less carbohydrate too, because the common channel is much shorter (75-150 vs 200-300).

Another concern, is that this procedure is considered "experimental" by many insurance companies. That means there are no billing codes for it. This means it often gets billed creatively.

Having said all that, most of the SIPS/SADI patients I work with have very high satisfaction post-op, and their numbers are not far off from the traditional DS patients - in the area where I am. This is anecdotal, though, note. And also, the DS is far less prone to complications than the internet would lead you to believe. Many DS patients also have high satisfaction, and are very pleased with their surgeries.

I have seen DS and SADI patients who have both gained weight post-op from inappropriate choices, though. And yeah, you can regain with even DS malabsorption. Part of what I do is counseling to very high risk and unsuccessful bariatric patients, and I have seen patients from all rgeries do poorly. I have also seen wildly successful DS patients, too!

The best way to make a decision is to talk to several DS patients and several SADI patients and see what they say, and what their experiences are.

Much of success is psychological, too, but malabsorption should not be underestimated. It's truly powerful.

In my case, my decision comes down to the last of my research. I have interviewed (grilled really) about fifteen surgeons at this point who do the DS and SADI. I have also read waaaay too many studies on both (probably 300). Truly, the difference is between 5-7% at most, which in my case would wind up being a difference of 10-15 pounds of weight loss. Unless you have had a BMI well over 50, the SADI will probably not net a worse result than the DS in the long run, assuming everything else in the same. Even then you will likely do "nearly" as well as a DS patient. It is far more important to eat lower carb with the SADI than the DS, as they absorb more carbohydrate (due to the longer common channel).

Again, though, much of the research is quite new. Anatomically and biochemically, though, they are very similar. The bigger risk is bile reflux is easier to get with the SADI from the anatomy's reconfiguration, which is then difficult to deal with. However, I have not seen anyone with any bile reflux yet.

I follow a ketogenic diet post-op. I also have a diagnosis of binge eating disorder. Feel free to ask me about either!

It is not that we have so little time but that we lose so much...the life we receive is not short but we make it so; we are not ill provided but use what we have wastefully. -- Seneca, On the Shortness of Life

Amy R.
on 6/26/17 2:24 pm

Thank you so much for all of that info Donna. I'm bookmarking it. =)

Dperry04
on 12/5/18 6:38 pm

Thanks so much for the information. I'm trying to decide between having a DS or SIPS as a revision from RNY from the year 2000. I'm looking to loose 75 lbs of excess weight that I have regained. Do you think instead of having a common channel at 300, shortening it to 250 would help fight off the regain in the future. I suppose I would need to know the real difference between a single and a double (whatever it's called) to know if having a SIPS surgery with a shorter common channel is just the same as the DS. What are your thought on this?

MarinaGirl
on 12/6/18 7:56 am
Revision with
On December 6, 2018 at 2:38 AM Pacific Time, Dperry04 wrote:

Thanks so much for the information. I'm trying to decide between having a DS or SIPS as a revision from RNY from the year 2000. I'm looking to loose 75 lbs of excess weight that I have regained. Do you think instead of having a common channel at 300, shortening it to 250 would help fight off the regain in the future. I suppose I would need to know the real difference between a single and a double (whatever it's called) to know if having a SIPS surgery with a shorter common channel is just the same as the DS. What are your thought on this?

You've responded to a 1.5 year old thread. I recommend you ask your questions in a new thread in the Duodenal Switch (DS) Forum in order to elicit more responses.

Lorrainecma
on 6/24/17 7:57 am
RNY on 03/22/11 with

I simply adore the fact that you have so much knowledge by all the research that you have done. I am considering revision now at 6 years out because I have gained about 40 lbs which I have tried to lose, but have succumbed t failure as I continue to fail over and over as I did prior to my original surgery. I have no knowledge of revision or the qualifying factors. I wonder if you have some knowledge of what meets the criteria for a revision?

Thanks,

Lora

    
Amy R.
on 6/26/17 2:32 pm

Lora, just a note.

I don't know your cir****tances but wanted to caution you about a revision. Forty pounds of regain can definitely be lost without going through the risk of a revision. I've lost regain; one of 40lbs and the second of 50 pounds. (Yes, I am a slow learner, lol). I believe there is also at least one person here on OH who is in the middle of addressing a 90+ pound regain. If I remember correctly she is a bit over half way through.

The point is that it can definitely be done. I weigh less now than I did at my lowest postop weight. I wrote a post on how I did it but it's lengthy and I don't want to spam the board. If you want to read it, PM me and I will send you a copy.

You can handle and rectify a 40 pound re-gain. Or any re-gain really. Once you learn how it will empower you to deal with any additional episodes. Because face it, re-gain is a face of bariatric surgery postop life. Ideally we just learn to catch and correct it sooner - at maybe ten pounds instead of forty or fifty.

Good luck.

Donna L.
on 6/27/17 5:42 pm - Chicago, IL
Revision on 02/19/18

Lora, it depends on your insurance company and the surgeon you work with. For the DS, my insurance requires me to have had a BMI of 50+ at the time of my first surgery. Regain isn't necessarily able to be used as revision criteria, but there are ways to appeal decisions and such, too. What you need to do is get the document from your insurance coverage that has the requirements for procedures - sometimes this is called the evidence of coverage. It will say there what your insurance requires for a revision.

I follow a ketogenic diet post-op. I also have a diagnosis of binge eating disorder. Feel free to ask me about either!

It is not that we have so little time but that we lose so much...the life we receive is not short but we make it so; we are not ill provided but use what we have wastefully. -- Seneca, On the Shortness of Life

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