SADI/DS Single Anastomoses Duodenoileostomy

The SADI/DS (Single Anastomoses Duodenoileostomy) is a relatively newer procedure endorsed by the ASMBS (American Society of Metabolic and Bariatric Surgery). It is the most powerful operation in our surgical arsenal, with excess weight loss (EWL) of 80-95%, and almost universal resolution of type 2 diabetes. It is known as the “anti-diabetes” operation as it is the most effective of any bariatric procedure in resolution of type 2 Diabetes. It is also one of the most effective revisional surgical options for weight loss in patients who have had weight regain or recidivism after previously having undergone a sleeve gastrectomy in the past. Dr. Cudworth performs the SADI using the DaVinci Xi Robotic system. SADI/DS is a very safe, effective operation to treat obesity, with powerful results with 80-95% of excess weight loss. Most patients lose in excess of 80 to over 100 lbs. You can expect to lose upwards of 80-95% of your excess weight (EW), and can expect significant improvement/resolution of type 2 Diabetes.

  • Most patients stay 1 - 2 nights in the hospital after SADI/DS. The morning after surgery you will undergo an Upper GI Series where you drink water soluble contrast to prove all the connections (anastomoses) look perfect, after which if you are drinking enough liquids and your pain is controlled with PO (oral) pain medications you can be discharged home.

  • The Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy, referred to as the SADI-S is the most recent procedure to be endorsed by the American Society for Metabolic and Bariatric Surgery. While similar to the BPD-DS (traditional Biliopancreatic Diversion-Duodenal Switch), the SADI-S is simpler and takes less time to perform as there is only one surgical bowel connection.

    The Procedure

    The operation starts the same way as the sleeve gastrectomy, making a smaller tube-shaped stomach.

    The first part of the small intestine is divided just after the stomach.

    A loop of intestine is measured several feet from its end and is then connected to the stomach. This is the only intestinal connection performed in this procedure. 60-75% of the small bowel is bypassed.

    How it Works

    When the patient eats, food goes through the pouch and directly into the latter portion of the small intestine. The food then mixes with digestive juices from the first part of the small intestine. This allows enough absorption of vitamins and minerals to maintain healthy levels of nutrition. This surgery offers good weight loss along with less hunger, more fullness, blood sugar control and diabetes improvement.

  • Although SADI is a newer/more modern procedure, the best available data we have from large multi-centric studies show an excellent safety profile, even better than the gastric bypass (which is already a very safe procedure). Overall data we have suggests a complication rate of 0.6%.

    In terms of results, most patients lose between 80-95% of their Excess Weight (EW), and the vast majority have remission or resolution of their obesity related comorbidities, such as Diabetes, Hypertension, Sleep Apnea, High Cholesterol, etc.

    Bariatric Surgery in general also decreases risk of many cancers including breast, colon, prostate, etc. It also has been shown to increase life expectancy in patients with severe obesity.

  • Advantages

    Highly effective for long-term weight loss and remission of type 2 diabetes

    Simpler and faster to perform (one intestinal connection) than gastric bypass or BPD-DS

    Excellent option for a patient who already had a sleeve gastrectomy and is seeking further weight loss

    Disadvantages

    Vitamins and minerals are not absorbed as well as in the sleeve gastrectomy or gastric band

    Newer operation with only short-term outcome data

    Potential to worsen or develop new-onset reflux (this is still up for debate, as more and more data shows it may actually improve reflux).

    Risk of looser and more frequent bowel movements.

  • Yes, it is critical that you take a Bariatric Multivitamin daily for the rest of your life. This is because the SADI/DS is an extremely powerful weight loss operation which alters the absorption capacity of the small intestine. After Surgery, we will follow you closely at regular intervals up to the 1 year mark, and then you should have an annual follow-up visit to check vitamin levels and other routine lab work.