Single Anastomosis Duodeno-Ileal Bypass (SADI)
SADI, medically termed the Single Anastomosis Duodeno-Ileal bypass, is also known as SADI-S (Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy). It is a modification of the duodenal switch (commonly referred to as a switch or DS), a resurgent bariatric procedure designed to promote weight loss and improve metabolic conditions such as high cholesterol, high blood pressure, sleep apnea, and type 2 diabetes.
The surgery involves two parts: First, a gastric sleeve or sleeve gastrectomy is performed to reduce stomach size, and second, a single-loop intestinal bypass is created by connecting the duodenum to a segment of the small intestine, bypassing a significant portion. In doing so, the SADI enhances weight loss by restricting food intake and limiting nutrient absorption while maintaining a single anastomosis (connection) to minimize the risk of complications compared to a switch, like bile reflux. Patients undergoing SADI can expect 70-80% excess bodyweight loss within 12 to 24 months after surgery, depending on their focus and adherence to dietary guidelines and lifestyle changes. SADI is considered an effective option for patients with severe obesity, offering substantial long-term weight loss and metabolic benefits.
Comparing the SADI and DS
SADI and DS are both bariatric surgeries designed for patients with severe obesity. While they share similarities, they also have key differences that should be discussed with a bariatric surgeon.
Similarities:
- Both procedures begin with a sleeve gastrectomy, where a significant portion of the stomach is removed to limit food intake.
- Both surgeries involve intestinal rerouting, bypassing part of the small intestine to limit nutrient absorption and enhance weight loss.
- Both procedures are highly effective for long-term weight loss and improving obesity-related conditions like type 2 diabetes.
Differences:
- The SADI only requires one connection versus the two the traditional DS requires. This reduces surgical risk significantly but slightly reduces malabsorption, reducing the weight a SADI patient can lose.
- The SADI has a lower risk of nutritional deficiencies
- SADI patients should expect 5-10% less excess body weight loss versus a DS. However, this represents a higher degree of excess weight loss versus the gastric sleeve or gastric bypass
- SADI has lower risks of bowel obstruction and bile reflux versus DS
SADI vs DS: Which One is Better?
- SADI is often preferred for patients who want significant weight loss while reducing the risk of nutritional deficiencies and complications.
- Traditional DS may be more suitable for patients with extremely high BMIs or those needing the most aggressive weight loss and metabolic benefits.
- Both surgeries are highly effective, and the choice depends on individual health conditions, weight loss goals, and risk tolerance. Consulting with a bariatric surgeon who performs both procedures regularly is the key to determining the best option.
- Health insurance coverage for SADI varies depending on the state, provider, policy, and specific patient circumstances. Your bariatric practice can help negotiate the insurance details.
SADI as a Revision to a Gastric Sleeve
SADI is an effective option for conversion surgery for patients who previously had a gastric sleeve (sleeve gastrectomy) but are experiencing inadequate weight loss, weight regain, or acid reflux.
Why Consider SADI as a Revision?
- Further Weight Loss – Some patients do not achieve their weight loss goals with a gastric sleeve alone, or they have regained weight over time. SADI uses the original sleeve and adds an intestinal bypass, enhancing weight loss through mild malabsorption.
- Improved Metabolic Effects – SADI is particularly effective for type 2 diabetes remission, insulin resistance, and high cholesterol, even in patients who had some improvement with the gastric sleeve but need additional help.
- Maintains a Single Anastomosis—When performed by an experienced surgeon, this procedure slightly reduces the risk of a DS or even a gastric bypass, as only one anastomosis is created.
- Lower Risk of Nutritional Deficiencies—While the risk of nutritional deficiencies is certainly higher than that of a gastric sleeve, these risks are relatively mild and manageable, especially compared to a traditional DS.
Expected Results After SADI Revision
Weight Loss: Patients typically lose 70-80% of their excess weight after the revision, depending on their focus on lifestyle changes and how much weight they lose from the gastric sleeve alone.
Diabetes & Metabolic Improvements: Many experience significant improvements or complete remission of type 2 diabetes, high cholesterol, and hypertension.
Satiation & Appetite Control: Due to changes in gut hormones, patients often feel fuller with less food and experience reduced hunger.
Is SADI the Right Revision for You?
If you’ve had a gastric sleeve but are now struggling with weight regain, worsened blood sugar, acid reflux, inadequate weight loss, or persistent metabolic conditions, SADI could be an excellent next step. A consultation with a bariatric surgeon is necessary to determine if it’s the best option based on your weight history, health status, and surgical goals.
