SADI Surgery - Single Anastomosis Duodenal-Ileostomy

Your surgeon will remove about 80% percent of the stomach, leaving the remaining portion of the stomach shaped like a tube (this is the sleeve gastrectomy). 

Just past the opening of the stomach (this is called the pylorus) is the duodenum. This is the first part of the small intestine. 

Your surgeon will divide the small intestine and shape it into a loop that is connected to the stomach. This is the only intestinal connection in this procedure.

How Does SADI Surgery Work?

• The smaller, newly created stomach holds less food, so fewer calories are ingested.
• More of the small intestine is bypassed, so less food is digested and absorbed.
• The altered food pathway alters the levels of gastrointestinal hormones that decrease hunger, increase fullness, enable the body to lose weight, and facilitate reaching and maintaining a healthy weight. This often improves obesity-related conditions, including diabetes.

Safe, Effective Weight Loss Surgery
Studies show that SADI surgery is safe and results in long-term weight loss. Excess weight loss and total weight loss were 70% to 85% and 35% to 38% at 5 to 10 years after surgery, respectively. It effectively:

• controls diabetes
• promotes feelings of fullness
• lowers high blood pressure
• lowers high cholesterol
• reduces sleep apnea problems.

Lower Risk of Ulcer and Bile Reflux
Because the small intestine is connected below the pylorus in the duodenum, there is a lower risk of a marginal ulcer when compared to Roux-en-Y gastric bypass or one anastomosis gastric bypass. 

This lower connection also prevents bile from flowing backward into the stomach or esophagus. It is uncommon, affecting only 2% of patients undergoing SADI. This may cause symptoms of stomach pain, heartburn, and a bitter taste in the back of the mouth.

Decreased Likelihood of Dumping Syndrome
Because the pylorus is preserved, there is a lower risk of dumping syndrome compared to other bariatric procedures.

Lower Risk of Leaks and Hernias
The single small intestine connection reduces the risk of leaks and internal hernias.

Less Risk of Diarrhea, Vitamin Deficiency, and Malnutrition
When food is ingested after surgery, it passes through the stomach, then 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.

 Nutritional supplementation and adequate protein intake are still needed. The risk is lower than with a duodenal switch, affecting 8 to 12% of people.

Increased Risk of Bowel Concerns
There is an increased risk of looser, more frequent bowel movements, and foul-smelling gas, especially when eating food high in fat.

Very Limited Insurance Coverage
Although the procedure was adopted as a standard bariatric surgery by the American Society for Metabolic and Bariatric Surgery, many insurance companies do not cover it. Blue Cross, Blue Shield of North Carolina, Aetna, and Duke employee insurance provide coverage.

More Technical Experience Required
Duke weight loss surgeons have been performing the procedure since 2018. They have years of experience altering the duodenum, which is an area of complex anatomy.

Typical Hospital Stay After SADI

• 2 to 3 days

Dietary Changes After Surgery

• First 2-3 weeks: full liquid diet
• First 3 months: soft foods
• After 3 months: gradual return to a regular diet, focusing on high-protein foods

You may find your food preferences change after surgery, especially regarding sweet foods. Our registered dietitians help you change your eating habits so you feel good after surgery.

Expected Pain After SADI: 
Pain levels vary by individual. Most patients find pain manageable, and our team will work with you to ensure your comfort during recovery.

Expected Weight Loss After SADI
60-80% of excess weight