Single-Anastomosis Duodenal Switch

Single-Anastomosis Duodenal Switch or Stomach Intestinal Pylorus Sparing Surgery (SIPS)

Single anastomosis duodenal switch (SIPS) primarily depends on intestinal malabsorption, but also utilizes gastric reduction to achieve weight loss. Firstly, a sleeve gastrectomy is performed to reduce the size of the stomach. The lowest part of the intestines, the ileum, is left undivided, but the duodenum is separated, leaving a small segment attached to the stomach and a longer free-hanging segment to which the liver and pancreas are attached. The ileum is brought up and re-connected to the duodenum segment. Digestion of protein and fat only occurs in the lower portion, about 7 feet long, of the lower intestines.

SIPS is a new type of duodenal switch procedure that made its debut less than 5 years ago and is still under investigation. The main differences between the classic DS and SIPS are the following. There is only one anastomosis between the stomach and the small intestines, as opposed to two in the DS. SIPS creates a longer common channel (through which nutrients pass through) resulting in less frequent bowel movements, less side effects, and less vitamin deficiencies.

On average, the surgery takes less than two hours to complete; patients are discharged 2-3 days post-op, and return to work after 2-4 weeks.

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Advantages

• Greater weight loss results
• Effective procedure to lower cholesterol and triglycerides
• Effective procedure in remission of type-II diabetes

Disadvantages

• May result in less weight loss in the long germ than a classic DS
• Long-term results are still under investigation

Risks

• Bowel obstruction, 2-4% in cases
• Need for reversal or reoperation due to malnutrition, 2-5% in cases
• Leakage, <1% in cases
• Bleeding, <1% in cases