Scripps Memorial Hospital La Jolla has become the first medical center in San Diego County to offer the newest available bariatric surgical procedure, giving another option to morbidly obese patients who need to lose a much larger amount of weight and to others who have regained weight following previous weight-loss surgery.
While the procedure, known as single anastomosis duodenal-ileal surgery or SADI, was endorsed by the American Society for Metabolic Bariatric Surgery in March 2019, it still is not widely available.
Kathie Lorkovic, 58, of Oceanside recently became one of the first Scripps patients to benefit from SADI. Since undergoing the surgery on Aug. 22, she has lost more than 45 pounds, down from her pre-surgery peak of nearly 300 pounds.
“The SADI procedure is an important advance in bariatric surgery,” said Sunil Bhoyrul, MD, the Scripps La Jolla bariatric surgeon who performed the procedure on Lorkovic. “We are seeing weight-loss results that are far better than with any other previous surgery.”
Scripps doctors hope SADI will help Lorkovic eventually lose as much as 150 pounds.
“Before the surgery, I was really in bad shape,” Lorkovic said. “I had put on 100 pounds during the pandemic. I had sleep apnea and only got a few hours of sleep at night. I couldn’t exercise anymore because I would get winded. I was having leg and knee pain, and I was limping when I walked. My oxygen levels were really low in the 88% range.
“I remember looking in the mirror and thinking I didn’t know who I was anymore. I was dying,” she said.
Almost immediately after the weight-loss surgery, Lorkovic noticed improvements.“It’s been a miracle,” she said. “I’m sleeping eight hours a night now with no problem, and the sleep apnea has completely gone away. I’m able to walk longer distances with much less discomfort. And my oxygen levels are above 95% where they should be.
“I feel better than I’ve felt in more than five years,” Lorkovic said. “I’m so excited about my new life.”
SADI is a simplified version of an older and more common bariatric surgical procedure. During the first part of the minimally invasive laparoscopic operation, surgeons perform a sleeve gastrectomy, which removes about 70% to 80% of the stomach, leaving a much smaller tubular organ. Then they connect the smaller stomach to the lower part of the small intestine, bypassing more than half the intestine while importantly ensuring the patient has at least 300 centimeters of intestine reconnected to the smaller stomach. The bypassed section of the smaller intestine is left in place where it continues to deliver digestive juices to the lower portion of the track.
The procedure can be done as a single surgery or two separate surgeries, depending on the specific needs each patient based on the surgeon’s assessment.
SADI produces weight loss by making patients feel less hungry overall and giving them a greater feeling of fullness from meals. It also reverses type 2 diabetes in most patients.
Compared with older bariatric surgeries, SADI bypasses a larger section of the small intestine, resulting in less fat and calorie absorption, while leaving a large section of the small intestine connected to the digestive system, which maintains nutrient absorption.
Still, as with other bariatric procedures, SADI reduces the overall absorption of nutrition from food, requiring patients to take nutritional supplements on a regular basis following the surgery.
SADI is particularly effective for morbidly obese patients (with a body mass index of 50 or higher) who tend to lose a lower percentage of their overall excess weight and have more difficulty keeping those pounds off following other bariatric procedures. Patients who have regained weight or not lost enough after a sleeve gastrectomy may also be good candidates for SADI.
Earlier this year, researchers in Spain reported in the medical journal Obesity Surgery that 87% of excess weight loss was maintained for five years following SADI surgery among patients tracked since 2007. At the 10-year mark, 80% of excess weight loss had been maintained.
For other patients who have had older types of bariatric surgery, SADI can be an effective follow-up procedure once their initial weight loss has plateaued and they start gaining back pounds.
“SADI is a safe and highly effective procedure with side effects that are easily managed under physician supervision,” Dr. Bhoyrul said.
While some health insurers cover much of the cost of SADI for qualifying patients, others do not.