Single Anastomosis Duodeno-Ileostomy (SADI)

The Single Anastomosis Duodeno-Ileostomy (SADI) is a relatively new, highly effective variant of the duodenal switch (DS), a procedure that has been in use for a few decades.

The SADI has grown in popularity as an alternative to the more complex DS, with similar (slightly lower weight loss potential) long-term results and fewer potential complications due to avoiding the second anastomosis or intestinal reconnection. On the flip side, SADI is a relatively new procedure with limited data, and some insurance companies still consider it experimental and may not offer coverage.

How Does It Work?

As in the DS, the SADI starts with forming a gastric sleeve by cutting away a portion of the stomach and removing it from the abdomen. This provides both mechanical and hormonal benefits by leaving approximately 25% of the stomach in the abdomen and removing the fundus, which is the primary production center for the hunger hormone ghrelin. This is a gastric sleeve or sleeve gastrectomy; However, the SADI goes further and bypasses a significant portion of the small intestine. The upper portion of the small intestine is cut near the stomach pouch area, and a loop of ileum (the last part of the small intestine) is brought up to reattach just below the stomach outlet known as the pylorus. This end-to-side connection is the only anastomosis performed during the SADI and represents less risk than a DS.

Operative time is about an hour under general anesthesia. Patients are often discharged home the following day unless health risks require a longer hospital stay.

>How Does It Work?

Benefits of the SADI Procedure

  • The SADI procedure offers several benefits. Compared to the most popular bariatric surgeries today, such as the gastric sleeve and gastric bypass, it provides greater potential for weight loss, with an average excess body weight loss of 70% to 80%. However, this can be enhanced if patients pay particular attention to their postoperative instructions and recommendations.
  • In part because of the combination of weight loss modalities, the improvements in obesity-related diseases are excellent and comparable to its cousin procedure, the duodenal switch.
  • Compared to the DS, SADI surgery is somewhat less complex and, therefore, has slightly fewer risks due to one fewer anastomosis or intestinal connection.
  • While occasionally being considered experimental by insurance companies, insurance coverage has expanded significantly over the past few years.

The Bottom Line…

The Single Anastomosis Duodeno-Ileostomy is a similarly effective and potentially safer procedure than the gold standard in excess body weight loss, the duodenal switch. With approximately 95% of the potential excess weight loss of the DS and fewer overall risks, it may be an option for qualifying patients with appropriate insurance coverage. 

That said, the best next step is for patients to consult with a knowledgeable, experienced bariatric surgeon like Dr. Tsuda, who performs a wide range of metabolic surgeries and offers non-surgical weight-loss options to qualifying patients. Learn more and schedule a consultation by clicking here. 

Please join us for an Online Seminar if you are ready to take the next step.