Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) is a bariatric procedure for significant weight loss and improved health. The surgery has a dual mechanism. It is restrictive, reducing stomach size through a sleeve gastrectomy to limit food intake. It is also malabsorptive, bypassing a portion of the small intestine to decrease the absorption of calories and fat.
Weight Loss Outcomes
The SADI-S procedure yields substantial and rapid weight loss, especially within the first year. Patients can lose 70% to 90% of their excess body weight (%EWL), with the most significant drop in the first six to twelve months. Weight loss stabilizes around the 18 to 24-month mark post-surgery.
Total body weight loss (%TBWL) is another metric for success. Long-term studies report an average %TBWL of 38% at five years and 34% at ten years post-surgery. These sustained results demonstrate the procedure’s effectiveness in long-term weight maintenance.
Individual results differ based on factors like starting Body Mass Index (BMI), adherence to dietary guidelines, and physical activity levels. Consistent follow-up with a medical team is necessary for patients to stay on track and manage their weight loss journey.
Resolution of Health Conditions
SADI-S improves or leads to the remission of many obesity-related health problems. The procedure is effective for Type 2 diabetes, with studies reporting remission rates between 60% and 80%. This allows many patients to reduce or eliminate their need for diabetes medications.
This metabolic improvement is not solely due to weight loss. The surgical bypass of the small intestine alters gut hormones that regulate blood sugar and satiety, contributing directly to better glycemic control. One study showed average HbA1c levels at 5.51% five years post-op.
Other health conditions also see high rates of improvement. Hypertension (high blood pressure) is controlled in over 60% of patients, with many achieving complete remission. Dyslipidemia (high cholesterol) and obstructive sleep apnea see remission rates of over 70% and 80%, respectively.
Surgical Risks and Side Effects
The SADI-S procedure carries potential risks. Early complications, while uncommon, include staple line leaks, bleeding, and infection. Surgeons test for leaks during the operation to minimize this risk, and the laparoscopic approach helps reduce surgical trauma and recovery time.
After recovery, patients may experience digestive changes due to the malabsorptive nature of the surgery. More frequent bowel movements, diarrhea, and malodorous gas can occur from the altered digestion of fats. These symptoms are often less severe than with the traditional duodenal switch procedure.
Dumping syndrome can occur if foods high in sugar move too quickly from the stomach to the small intestine, causing nausea, cramping, and dizziness. The risk with SADI-S is lower compared to other bypass surgeries because the pyloric valve is preserved, which helps regulate the stomach’s emptying process.
Long-Term Nutritional and Lifestyle Adjustments
The anatomical changes from SADI-S surgery require lifelong dietary adjustments. Because the procedure reduces nutrient absorption, patients must commit to a permanent regimen of vitamin and mineral supplements to prevent serious deficiencies.
Malabsorption primarily affects fat-soluble vitamins and other nutrients. Lifelong daily supplementation is required for:
- Vitamin A
- Vitamin D
- Vitamin E
- Vitamin K
- Iron
- Calcium
- Vitamin B12
Regular blood tests are needed to monitor nutrient levels, as deficiencies can occur even with supplementation, requiring close medical supervision.
A high-protein diet is necessary to prevent muscle loss and malnutrition. Patients work with dietitians to adopt new eating habits, focusing on nutrient-dense foods and smaller portions. This dietary management is part of the long-term commitment to health after surgery.