SADI-S

If you have a very high BMI, have struggled with significant weight regain after a previous bariatric procedure, or have serious obesity-related health conditions that have not been adequately controlled with other treatments — the SADI-S may be exactly the procedure you have been looking for. It is the most powerful weight loss operation available today, and for the right patient, it produces results that are truly extraordinary. I am genuinely excited to offer this procedure as part of our comprehensive bariatric program, and I look forward to helping you find out whether it might be the right choice for you.

SADI-S stands for Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy. It is an advanced bariatric procedure that combines two powerful weight loss mechanisms — a sleeve gastrectomy and an intestinal bypass — into one operation, producing the highest average weight loss of any standard bariatric procedure available.

Here is how it works in simple terms. First, the stomach is reduced to a narrow sleeve — exactly like a standard sleeve gastrectomy — dramatically limiting how much food you can eat at one time and significantly reducing the hunger hormone ghrelin. Second, the small intestine is rerouted so that food bypasses a very long segment — typically 250 to 300 centimeters — of the small intestine. This means that a large portion of the calories and fat you eat are simply not absorbed by the body. The combination of eating less and absorbing less produces the most dramatic and sustained weight loss of any procedure we offer.

What makes SADI-S particularly exciting from a medical standpoint is the profound effect it has on the body's hormones and metabolism. The dramatic changes in gut hormones triggered by the long intestinal bypass produce rapid and powerful improvements in type 2 diabetes, high blood pressure, high cholesterol, and other metabolic conditions — often within days to weeks of surgery, long before maximum weight loss is achieved.

Understanding how SADI-S compares to other procedures helps explain why it is recommended for specific patients:

Compared to Sleeve Gastrectomy

• The sleeve alone produces excellent weight loss but works primarily through restriction and ghrelin reduction
• SADI-S adds the powerful component of intestinal bypass — dramatically increasing weight loss and metabolic improvement beyond what the sleeve alone can achieve
• For patients who had a sleeve gastrectomy and experienced significant weight recurrence, conversion to SADI-S is an increasingly popular and highly effective revisional option

Compared to Gastric Bypass

• Traditional gastric bypass bypasses approximately 100 to 150 centimeters of small intestine
• SADI-S bypasses 250 to 300 centimeters — nearly double — producing significantly greater weight loss and more powerful metabolic effects
• SADI-S requires only one internal connection rather than two — making it technically simpler than traditional gastric bypass and eliminating the risk of internal hernia
• Diabetes remission rates after SADI-S are among the highest of any bariatric procedure — exceeding even those of gastric bypass in many studies

Compared to Traditional Duodenal Switch (BPD-DS)

• The traditional duodenal switch is one of the oldest and most powerful bariatric procedures — but it requires two surgical connections and is technically very complex
• SADI-S was developed as a simplified version of the duodenal switch — achieving comparable or superior weight loss results with only one connection and a simpler surgical design
• The simpler design of SADI-S reduces operative time, technical complexity, and certain surgical risks compared to the traditional duodenal switch

SADI-S is performed laparoscopically — through small keyhole incisions — while you are completely asleep under general anesthesia. Here is what happens:

Step One — Sleeve Gastrectomy The first part of the procedure is identical to a standard sleeve gastrectomy. The stomach is reduced to a narrow tube — removing approximately 70 to 80% of the stomach and dramatically reducing both capacity and the hunger hormone ghrelin. This step alone begins the weight loss process and sets the foundation for the procedure.

Step Two — Dividing the Duodenum Just below the stomach, the first part of the small intestine — called the duodenum — is carefully divided. This separates the stomach from the duodenum and prepares for the intestinal rerouting that is the second component of SADI-S.

Step Three — The Single Anastomosis The small intestine is measured carefully from its far end — typically 250 to 300 centimeters — and this measured loop is brought up and connected directly to the divided duodenum. This single connection — the one anastomosis — is what gives SADI-S part of its name. Food now travels from the esophagus through the sleeve stomach into the duodenum and directly into this loop of intestine — bypassing the long measured segment where most calorie and fat absorption would normally occur.

Testing and Closing All staple lines and the anastomosis are carefully inspected and tested to make sure everything is completely sealed. Hiatal hernia repair is performed at the same time if needed. The procedure typically takes 90 minutes to 2 hours in experienced hands, and most patients go home 1-2 days post-surgery.

Recovery from SADI-S is similar to other laparoscopic bariatric procedures. You will be up and walking within a few hours of surgery — early movement is essential for preventing blood clots and speeding recovery. Pain is typically well controlled with medication, and most patients go home the day after surgery.

Your diet progresses gradually to allow full healing:

• Weeks 1 to 2 — clear liquids for the first few hours, advancing to full liquids and protein shakes sipped slowly and frequently throughout the day
• Weeks 3 to 4 — pureed smooth foods high in protein
• Weeks 5 to 6 — soft easily chewed foods
• After 6 weeks — a healthy regular diet with small portions focused heavily on lean protein

Protein is especially critical after SADI-S — because the longer intestinal bypass means less protein absorption, adequate daily protein intake is essential to prevent muscle loss and maintain strength. Our dietitian will work closely with you to make sure your protein goals are met every single day.

Because SADI-S bypasses a longer segment of small intestine than any other standard bariatric procedure, nutritional supplementation is especially critical and non-negotiable. The risk of deficiencies in fat-soluble vitamins — particularly vitamins A, D, E, and K — as well as protein, iron, calcium, zinc, and vitamin B12 is higher after SADI-S than after sleeve or standard gastric bypass.

Lifelong supplementation after SADI-S includes:

• High-dose bariatric multivitamin — twice daily
• Calcium citrate — 1,500 to 2,000 mg daily in divided doses
• Vitamin D — high dose, typically 5,000 to 10,000 IU daily
• Vitamin A — monitored closely and supplemented as needed
• Vitamin B12 — sublingual or injectable
• Iron — particularly important for women
• Zinc and copper — monitored and supplemented as needed
• Regular blood work — every 3 to 6 months in the first year and at least annually thereafter

This level of nutritional monitoring is not optional — it is the most important long-term responsibility of every SADI-S patient, and our team takes it very seriously. Patients who are committed to their vitamins and follow-up blood work do exceptionally well long term. Those who are not consistent with supplementation risk serious and potentially permanent nutritional complications. We will make sure you are fully prepared, fully supported, and fully informed before proceeding.

The results of SADI-S are the most impressive of any standard bariatric procedure — and the growing body of long-term evidence is consistently remarkable:

Weight Loss

• Most patients achieve total excess weight loss of 70 to 90% — one of the highest of any standard bariatric procedure
• Weight loss is most rapid in the first 12 to 18 months and continues more gradually through the second year
• Long-term weight loss maintenance after SADI-S is excellent — with studies showing durable results 5 and 10 years after surgery in the majority of patients who adhere to dietary and supplementation guidelines
• For patients with a BMI over 50 or 60 — who often find that other procedures do not produce adequate weight loss — SADI-S offers one of the most powerful and reliable path to meaningful, sustained weight reduction

Health Improvements The metabolic improvements after SADI-S are the most profound of any bariatric procedure:

• Type 2 diabetes — improves or resolves in up to 90 to 95% of patients — the highest remission rate of any bariatric procedure, and one of the most compelling reasons to consider SADI-S for patients with significant diabetes
• High blood pressure — improves or resolves in up to 80 to 90% of patients
• High cholesterol — dramatically improves in the vast majority of patients — with some of the most significant lipid improvements seen with any bariatric procedure
• Sleep apnea — improves or resolves in up to 85 to 90% of patients
• Fatty liver disease — improves or resolves in the majority of patients
• Joint pain and mobility — improves dramatically as weight comes off
• Cancer risk — meaningfully reduced as obesity-related metabolic dysfunction is addressed
• Overall quality of life — improves profoundly and consistently for the vast majority of patients

SADI-S is a powerful procedure that produces extraordinary results — but it is not the right choice for every patient. It is most appropriate for carefully selected individuals who will benefit most from its greater degree of weight loss and metabolic change. SADI-S may be particularly well suited for:

• Patients with very high BMIs — particularly those with a BMI over 50 or 60 — for whom other procedures may not produce adequate weight loss
• Patients with severe type 2 diabetes — seeking the highest possible rates of remission
• Patients with multiple serious obesity-related health conditions — who need the most powerful metabolic intervention available
• Patients who have had a previous sleeve gastrectomy and experienced significant weight regain — for whom conversion to SADI-S is an increasingly recognized and highly effective revisional option
• Patients who have not achieved adequate results with other bariatric procedures and need a more powerful intervention

SADI-S requires additional consideration and thorough discussion for patients who:

• Are not able to commit to lifelong vitamin supplementation and regular blood work — as the nutritional consequences of non-compliance are more serious with SADI-S than with any other standard procedure
• Have significant pre-existing nutritional deficiencies that need to be corrected before surgery
• Have certain medical conditions affecting intestinal function or absorption

Coming in for a consultation to discuss SADI-S is the most important first step — and we have designed our evaluation process to be as thorough, welcoming, and informative as possible. Here is what you can expect:

A Comprehensive Evaluation We begin with a thorough review of your complete medical history, weight history, previous weight loss attempts and procedures, and current health conditions. For patients considering SADI-S — particularly those with a previous sleeve gastrectomy — we perform a detailed assessment of your current anatomy, nutritional status, and metabolic health to ensure you are the right candidate for this powerful procedure.

Diagnostic Testing Depending on your history, we may recommend upper endoscopy, nutritional blood work, imaging studies, and other evaluations to fully assess your anatomy and health status before making a procedure recommendation.

An Honest and Thorough Discussion We will sit down together and go through all available procedure options — explaining the differences between sleeve gastrectomy, gastric bypass, OAGB, SADI-S, and other procedures — so you can make a fully informed comparison. We will discuss the specific risks, benefits, and nutritional requirements of SADI-S in detail — because informed patients make better decisions and have better outcomes. Our goal is for you to leave your consultation feeling completely empowered, fully informed, and genuinely excited about your path forward.

No Pressure and No Judgment Whatever your weight history, whatever procedures you may have had before, whatever has brought you to this point — you are welcome here, and you deserve our very best. There is no judgment in our practice — only expertise, compassion, and a genuine commitment to helping you achieve the health outcomes you deserve.

The bottom line: SADI-S is the most powerful weight loss and metabolic procedure available today — and for patients who need maximum results, it offers possibilities that no other standard bariatric procedure can match. Extraordinary weight loss, exceptional diabetes remission, and life-changing improvements in overall health are within reach for the right patient. Finding out whether you are that patient starts with a single consultation — and I genuinely look forward to having that conversation with you. That conversation starts here.