Learning About Single Anastomosis Duodenal-Ileal Bypass With Sleeve Gastrectomy (SADI-S)

Single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) is surgery. It can help people with severe obesity lose weight. Your doctor may recommend SADI-S if you:

• Have a body mass index (BMI) of 35 or higher.
• Have a BMI of 30 or higher and a health condition like type 2 diabetes, high blood pressure, or high cholesterol.
• Had surgery to make your stomach smaller (a sleeve gastrectomy) but didn’t lose as much weight as you wanted to. Or maybe you lost weight and gained it back.

SADI-S is done in two parts. The first part is a sleeve gastrectomy. This is surgery to make your stomach smaller and create a sleeve-like shape. A smaller stomach means you won’t be able to eat as much in one sitting.

The second part is a single anastomosis duodenal-ileal bypass. This will connect the latter part of your small intestine directly to your stomach. Bypassing part of the small intestine means your body will absorb fewer calories from food. This helps you lose weight. Changing the way food passes through your stomach and digestive system also changes your metabolism. (That is the way your body turns food and drink into energy.) For example, your body starts:

• Making less of the hormone that makes you feel hungry.
• Absorbing less sugar (glucose) from your food.
• Making more of other hormones that help your body regulate blood sugar levels. That can improve type 2 diabetes.

Before surgery, the doctor will give you medicine to make you fall asleep (general anesthesia). You won’t feel any pain.

First, the doctor will do the sleeve gastrectomy to make your stomach smaller. If you already had a sleeve gastrectomy in the past, the doctor will skip this part and only do the bypass part of the surgery. To do the sleeve gastrectomy, the doctor makes several small cuts to your stomach and inserts small surgical tools. The doctor uses staples or stitches to make your stomach smaller and creates a narrow, sleeve-like shape. After the surgery, your stomach will be about 80% smaller than before.

Next, the doctor will do the bypass part of the surgery. For that, they will divide the first part of your small intestine just after the stomach. Then they will measure a loop of intestine and connect it to your stomach. This means food will travel less distance through your intestine, giving the body less time to absorb calories.

SADI-S has important benefits. People usually have a total weight loss of 35% to 40% within two years after the surgery. Getting to a weight that’s healthy for you lowers your risk of health problems like heart disease and high blood pressure. SADI-S can also help you manage and improve type 2 diabetes.

SADI-S also comes with some side effects and risks. Because food travels through your digestive system faster, your body absorbs fewer calories. But it also absorbs fewer vitamins and minerals. This means you’ll have to take supplements to make sure your body gets enough important nutrients. Some people have stomach problems after the surgery. These can include acid reflux, diarrhea, foul-smelling gas, or loose bowel movements.

There are also possible risks from the surgery itself. These risks include bleeding, blood clots, infections, and problems from the anesthesia.

Talk with your doctor to make sure you understand all the benefits and risks before you make a decision about having SADI-S.

After the surgery, you’ll stay at the hospital for a day or two. Then you’ll recover at home for a few weeks. After that, you can resume your normal activities.

You’ll have to follow a special diet while you recover from the surgery. You'll start with a liquid diet and move on to soft foods over time. Even after your stomach and intestines are healed, you’ll have to manage what you eat carefully. Talk with your doctor about what a healthy eating plan looks like for you after SADI-S.

To make sure you're staying healthy, you'll have regular follow-up visits with your doctor. Some of these visits will include blood tests to check if you’re getting the nutrients you need.

Keep in mind that SADI-S and other weight loss surgeries are only one piece of your obesity treatment plan. It’s still important to follow any other weight loss strategies you and your doctor agreed on, like eating healthy foods and being active.