At BodyByBariatrics, we are excited to introduce a new bariatric surgery option: the SADI procedure (Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy) (aka Modified Duodenal Switch (ModDS), SADS, SIPS, SADI-S, loop DS procedure), a modified version of the Duodenal Switch (DS) surgery. If you’ve struggled with significant weight loss or have health conditions like Type 2 diabetes, especially if uncontrolled, the SADI may be the best bariatric surgery option for you. 

What Is the SADI Procedure?

The SADI is a hybrid bariatric surgery that combines both restrictive and malabsorptive components, leading to dramatic weight loss. It’s a simplified variation of the traditional Duodenal Switch, involving two main steps: 

1. Sleeve Gastrectomy: The first part of the procedure involves removing approximately 80% of the stomach. What remains is a slender, tube-like stomach or “sleeve,” which drastically reduces the amount of food you can eat at one time. This restrictive element helps patients feel full after smaller meals, significantly reducing caloric intake. 
2. Duodenal-Ileal Bypass: In the second part of the surgery, the first portion of the small intestine (the duodenum) is disconnected and rerouted directly to the lower part of the small intestine (the ileum), bypassing a large section of the digestive tract. This malabsorptive component reduces the absorption of calories and nutrients, intensifying weight loss. 

One key difference with the SADI is the single connection point (anastomosis) between the stomach and small intestine, as opposed to the two connections in the traditional Duodenal Switch. This simplifies the procedure and reduces some associated risks, while still offering comparable results in terms of weight loss and metabolic improvements. 

Who Is the Ideal Candidate? 

While the SADI procedure offers exceptional weight loss potential, it’s not for everyone. The ideal candidate typically has: 

• BMI over 55: Patients with a BMI over 55 kg/m² who need to lose a significant amount of weight are prime candidates for SADI. 
• Uncontrolled Type II Diabetes: Those with severe Type II diabetes dependent on insulin often benefit from the procedure’s ability to improve blood sugar control, sometimes leading to remission of diabetes altogether.   
• Dedication to Lifelong Care: SADI requires a lifelong commitment to vitamin and nutrient supplementation due to the malabsorption of critical nutrients. Patients must be highly motivated, detail-oriented, and dedicated to their health post-surgery, ensuring they follow strict supplement routines.   
• Frequent NSAID or Steroid Use: This surgery is a strong option for patients who take NSAIDs (nonsteroidal anti-inflammatory drugs) or oral steroids for chronic conditions. Unlike procedures such as the Roux-en-Y Gastric Bypass, which are associated with a higher risk of ulcers, SADI presents minimal ulcer risk. 
• Type A Personality: If you’re someone who’s meticulous, organized, and fully aware of the discipline required for long-term health maintenance post-surgery, SADI could be a great fit for you. 

Key Benefits of SADI 

The SADI procedure offers a number of compelling advantages, making it a popular choice for patients looking for more than just modest weight loss: 

• Superior Weight Loss: SADI patients often experience some of the most significant weight loss results. This can be life-changing, especially for individuals who’ve struggled with extreme obesity.
• Improved Diabetes Control: For those with uncontrolled Type 2 diabetes and dependent on insulin, the metabolic benefits of SADI can lead to substantial improvements in blood glucose levels, reducing the need for insulin or medications. In most cases, diabetes goes into complete remission. 
• Lower Risk of Ulcer Disease: Because of the specific way the intestines are rerouted, SADI offers a low risk of ulcer development compared to other bariatric procedures.  
• Durable Long-Term Weight Loss: The combination of restrictive and malabsorptive mechanisms ensures that the weight loss results of SADI are long-lasting. Many patients maintain significant weight loss years after surgery. 

Risks and Considerations 

Like any surgery, the SADI procedure comes with its own risks. It’s important to discuss these in depth with our BodyByBariatrics Team. Some potential complications include: 

• Acid Reflux: Patients with pre-existing acid reflux should approach SADI with caution, as this procedure can worsen symptoms or create new issues with reflux. 
• Nausea and Vomiting: Some patients may experience prolonged nausea and vomiting post-operatively, especially in the initial recovery phase. 
• Diarrhea and Malabsorption: Due to the shortened length of the small intestine, some patients may experience looser stools or more frequent bowel movements. Diarrhea can be an issue, especially with high-fat meals, as the body has a reduced capacity to absorb fats. 
• Leaks at the Staple Line: There is a risk of leak from the sleeve staple line or the anastomosis. This can be a serious complication that requires immediate attention. 
• Small Bowel Obstruction: This is a rare but serious complication where the intestines can become obstructed, requiring medical intervention. 

Patients must commit to a lifetime of nutritional monitoring. Since the malabsorption of key nutrients like iron, calcium, vitamins D and B12 is a significant factor, patients will need daily supplements to avoid deficiencies. Regular lab work and follow-up appointments are critical to monitor for these deficiencies and adjust supplementation as needed.

While the SADI procedure offers significant benefits, it’s important to note that many insurance companies do not yet cover it due to its relatively new status in bariatric surgery. However, at BodyByBariatrics, we understand the importance of having access to effective weight loss solutions, which is why we offer self-pay pricing starting at $12,499. This option allows patients to take advantage of the SADI procedure without the limitations of insurance, providing a more immediate path to achieving long-term weight loss and health improvements. Our team is available to discuss financing options through CareCredit  and help make this life-changing procedure accessible. 

How the Procedure Works in Detail 

The SADI procedure typically takes approximately 60 minutes to complete and is performed laparoscopically, meaning smaller incisions are made, leading to quicker recovery times. 

1. Anesthesia and Incisions: After administering general anesthesia, Drs. Dovec and Lane make 4 incisions in the abdomen, where surgical instruments and a camera are inserted. 
2. Sleeve Gastrectomy: The first step is creating the sleeve by removing about 80% of the stomach. This leaves behind a tube-shaped stomach that limits food intake and reduces hunger, as the part of the stomach that produces the hunger hormone, ghrelin, is removed. 
3. Single Anastomosis: Instead of rerouting the intestines twice, the SADI creates a single connection between the remaining stomach and the lower part of the small intestine, the ileum. This bypasses a large portion of the small intestine, limiting the absorption of calories and nutrients. 
4. Rerouting the Digestive Path: The new digestive pathway allows food to bypass a significant portion of the intestine, reducing caloric absorption, while still allowing enough of the small intestine to absorb essential nutrients. 
5. Post-Surgery Recovery: After the surgery, most patients are immediately walking, urinating and drinking and being prepared for discharge. Recovery typically involves a diet transition from liquids to solid foods over several weeks as outlined in our Bariatric Surgery Success Guide.

Is SADI Right for You? 

The SADI procedure is a powerful tool for those who have struggled with weight loss and metabolic issues. If you have a BMI over 55, have severe Type II diabetes, or use NSAIDs or steroids regularly, SADI could be the key to unlocking a healthier future. However, it’s essential to weigh the benefits against the lifelong commitment to supplements and the risk of acid reflux.  

BodyByBariatrics is here to guide you every step of the way. If you think SADI may be the solution you need, schedule a VIRTUAL consultation with our expert team to explore your options and start your journey toward lasting weight loss and better health! 

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XOXO,
BodyByBariatrics

*BodyByBariatrics blog does not replace medical advice. Seek the help of your healthcare professional if you have questions related to your condition. We strive for patients to achieve healthier, happier, longer lives through weight loss surgery.