The SIPS procedure for dilated sleeves as an alternative to Gastric Bypass
Dr Padovan is offering the SIPS to the following groups of patients:
- Sleeve Gastrectomy patients who have regained weight over several years
- Patients looking for an initial procedure more powerful than a Sleeve Gastrectomy but wanting an alternative to Gastric Bypass to avoid medium and long term adverse events such as dumping syndrome
SIPS stands for Stomach Intestinal Pylorus-Sparing Surgery. The other technical name is Sleeve Gastrectomy with a loop duodeno-ileostomy.
In essence SIPS involves the following:
- Performing a standard Sleeve Gastrectomy
- Dividing the duodenum just beyond the stomach
- Hooking up the small bowel to the duodenum so that over half the bowel is bypassed thereby inducing malabsorption of calories
Why SIPS intead of Gastric Bypass?
The SIPS procedure is fairly new and requires further evaluation to ensure long term efficacy and safety. It is intended to reduce the complications of the classic gastric bypass (Roux-en-Y Gastric Bypass). Roux-en-Y Gastric Bypass Surgery can be associated with a range of possible adverse effects over time including:
- Marginal ulcers at the join between the stomach pouch and the small intestine
- Small bowel obstruction from it getting stuck in internal hernias
- Dumping syndrome
- Unstable blood sugar fluctuations
- Excessive food intolerance/restriction
In theory, because of the way the SIPS is constructed, most of these problems should not occur. The procedure has been approved as a weight loss procedure by the American Society of Bariatric and Metabolic Surgery.
Early results show that weight loss is similar to Gastric Bypass and adverse events are low.
The other promising role for the SIPS procedure is for Sleeve Gastrectomy patients who have regained some of their weight back or did not achieve a satisfactory outcome in the first place. The SIPS is not suitable for patients with severe oesophageal reflux and Barrett’s oesophagus changes. These patients might be better served by conventional Roux-en-Y Gastric Bypass.
Converting a Gastric Sleeve to SIPS is fairly straightforward and should take no more than about 30-40 minutes of operating time.
Benefits of SIPS
- Beneficial effect on diabetes
- Ability to eat normally like with the sleeve
- No dumping syndrome as seen in Roux-en-Y Gastric Bypass due to pylorus preservation
- No increased risk of anastomotic ulcers
- No increased risk of internal hernias
- Excellent technique for unsatisfactory sleeve results as it avoids anastomosis in area of adhesions and scarring from prior surgery
- Avoids he controversy of gastric cancer in the gastric remnant due to bile reflux as in Omega loop or Mini Gastric Bypass
- Suitable for patients with previous Nissen fundoplication for reflux
Risks of SIPS
- Long term data beyond 5 years is not available
- Increase in number of bowel movements to average 2.5 times
- Wound problems: Wound infection (<5%), hernia development (1% for laparoscopic)