Single Anastomosis Duodenal Switch

Single Anastomosis Duodenal Switch (SIPS)

This procedure is also known as the Stomach-Intestinal Pylorus Sparing procedure Regardless of the name, this operation is a duodenal switch surgery (DS) that delivers both stomach restriction and decreased absorption. The first part of the surgery is performed by reducing the size of the stomach. A sleeve is created, however, the sleeve is created in a larger capacity similar to the original duodenal switch.

In the second part of the surgery, the duodenum is separated 3 cm from the pyloric valve, from the remaining intestinal tract. Around 300 centimeters of the small intestine is measured from the terminal ileum and that loop is connected to the duodenum. This longer channel leads to greater absorption of nutrients and vitamins and fewer bowel movements compared with the regular Duodenal Switch procedure (DS).

The main difference between a SIPS and DS is the way the intestine is connected to the duodenal stump. In a SIPS procedure, the intestine is connected to the duodenum from a loop of intestine so there is only one connection. In a standard DS, the bowel is divided with one limb going to the intestine and a second anastomosis to sew the intestine back to itself. There are two connections in a classic DS. SIPS is a modification of the existing operation that seeks to reduce the complications related to roux limbs and reduce diarrhea, helping patients maximize the benefits from DS surgery. This is an operation that can be considered after unsuccessful weight loss with a sleeve gastrectomy in a patient that does not have reflux.

How is a SIPS procedure done:

SIPS surgery is very similar to other forms of bariatric surgery, like Roux-en-Y gastric bypass or sleeve gastrectomy procedures. Surgeries take place laparoscopically meaning that the process is minimally-invasive for optimal recovery.

SIPS procedures are often slightly longer than other forms of bariatric surgery, lasting three to four hours. However, hospital stays are short, with most patients returning home in 48 to 72 hours.

What Are the Benefits and Risks of SIPS Bariatric Surgery?

Just like standard duodenum bypass surgery, there are both risks and benefits to consider in SIPS surgery.

Advantages:

• Weight loss greater than VSG or RYGB
• Higher resolution of diabetes
• Research suggests lower rates of ulcers, strictures and small bowel obstruction
• Less fluctuations in blood sugar than gastric bypass
• Similar weight loss than classic DS, with suggestion of lower complications.

Disadvantages:

• Potential risk of nutritional deficiency
• A new procedure with very little long term data in comparison to the standard RYGB or the classic DS
• Can be offered for patients who want additional weight loss with existing sleeve ie a second stage of surgery, as long as no reflux exists.