Single Anastomosis Duodenal-Ileal Switch (SADI-S) Surgery

Overview

Single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S), also known as single anastomosis duodenal switch (SADI), is a relatively new procedure that combines a sleeve gastrectomy with a single bowel connection. This slightly differs from the traditional duodenal switch which has two bowel connections.

The procedure is performed laparoscopically or robotically. This simplified approach removes about 80 percent of the stomach and connects a loop of the intestine directly to the duodenum, making it both a restrictive and malabsorptive procedure.

Candidates for SADI surgery

Patients considered for SADI surgery typically have:

• A BMI of 40 or greater
• At least 100 pounds of excess weight
• Obesity-related conditions including (but not limited to) diabetes, sleep apnea or high blood pressure
• Previous unsuccessful weight loss attempts
• A commitment to lifelong follow-up care

Expectations from SADI surgery

For the duration of your surgery, you will be asleep under general anesthesia. Studies show that patients can expect:

• 87 percent excess weight loss at five years
• 80 percent excess weight loss maintained at 10 years
• Effective control of diabetes
• Lower blood pressure and cholesterol
• Reduced sleep apnea problems

Recovery from SADI surgery

After surgery, you'll follow a specific progression of dietary stages:

• Initial liquid-only diet
• Gradual progression to soft foods
• Eventually incorporating regular bariatric diet foods
• Lifelong commitment to vitamin and mineral supplements

You'll need to be mindful of:

• Proper nutrition and supplement intake
• Regular follow-up appointments
• Potential for more frequent bowel movements, especially when consuming high-fat foods
• The importance of maintaining adequate protein and fluid intake

Risks and side effects associated with SADI surgery

While SADI has fewer complications than traditional duodenal switch, there are still significant risks to consider.

Surgical risks

Surgical risks are common with any form of bariatric surgery, but are still worth noting:

• Bleeding and blood clots
• Infection
• Leaking at the surgical connection
• Bowel obstruction
• Hernias
• Organ injuries

Long-term risks

SADI often leads to worsened nutrient and mineral absorption, requiring patients to follow a specific regimen to maintain adequate nutrition. Other long-term risks include:

• Increased bowel movements and malodorous gas, especially with high-fat foods
• Potential for reflux (though less than with sleeve gastrectomy)
• Risk of kidney stones
• Malnutrition if supplements aren't taken as directed
• Nausea, vomiting, diarrhea, or constipation

Many of these risks can be minimized through:

• Regular follow-up appointments
• Strict adherence to dietary and supplement guidelines
• Ongoing nutritional monitoring
• Prompt attention to any post-surgical concerns

When you should consider SADI surgery

SADI surgery may be right for you if:

• You have severe obesity with a BMI of 40 or higher
• You have serious obesity-related health conditions
• Previous weight loss methods have been unsuccessful
• You're committed to making permanent lifestyle changes
• You understand the need for lifelong nutritional supplementation and medical follow-up

The surgery is also an excellent option for patients who have previously underwent bariatic surgery, like sleeve gastrectomy, but haven't achieved their desired weight loss goals.