Why is there so much hype about SADI-s bariatric surgery? By Edmund B. Chen on April 21, 2023

SADI-S SADI-S stands for Single Anastomosis Duodenal-Ileal bypass with Sleeve gastrectomy.  The first part of this operation is creating a sleeve gastrectomy, by stapling the stomach and removing about 70% of the stomach in the usual fashion.  Then, the sleeve stomach is disconnected from the first portion of the intestine.  The sleeve stomach then gets rejoined to a loop of small intestine that is about 300 cm from the end of the small intestine.  In this configuration, food passes down through the sleeve stomach, and then through this 300 cm of small intestine.  The 300 cm of small intestine is then responsible for the absorption of food and approximately 400-600 cm of small intestine is bypassed.

In my opinion, the SADI-S operation is one of the best bariatric surgeries we have today.  It is a much more powerful metabolic surgery than the sleeve gastrectomy and the RYGB.  As a result, it offers on average, more weight loss than either the sleeve gastrectomy or the RYGB. Literature shows that patients lose approximately 70-80% of their excess weight loss after a SADI-S operation. 

The SADI-S offers numerous benefits over the RYGB.  One very important benefit of the SADI-S over the RYGB is that the SADI-S has a much lower rate of marginal ulcers than the RYGB.  Marginal ulcers are the crux of the RYGB.  Marginal ulcers are ulcers that form at the connection between the small gastric pouch and the limb of small intestine that is brought up to it.  In a RYGB, rates of marginal ulcers range from 5-20%. In a SADI-S, rates of marginal ulcers are less than 1%.  In addition, since the SADI-S preserves the pylorus, the natural valve of the stomach, the rates of dumping syndrome after a SADI-S are almost non-existent.

The SADI-S operation is one of the most promising bariatric surgeries today.  However, given the complexity of the operation and the expertise needed to perform this surgery, it is not performed by all centers.  The surgery itself and the care of patients with a SADI-S should be performed only by experienced surgeons.


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