Gastric bypass to SADI‑S conversion is a revisional bariatric procedure for patients who experience inadequate weight loss, weight regain, or metabolic relapse after Roux‑en‑Y gastric bypass (RYGB). The procedure restores normal anatomy by reversing the bypass, recreates a sleeve gastrectomy, and adds a powerful intestinal bypass through a single‑anastomosis duodeno‑ileostomy. This provides stronger metabolic improvement and more durable long‑term weight loss.

The gastric bypass anatomy is taken down by reconnecting the gastric pouch to the remnant stomach. A sleeve gastrectomy is created or revised. The duodenum is divided just beyond the pylorus, and the ileum is connected to the duodenum in a single‑anastomosis configuration. This enhances metabolic signaling and reduces calorie absorption.

Benefits include stronger metabolic improvement, improved weight loss durability, reduced hunger, improved satiety, and reversal of complications related to gastric bypass such as dumping syndrome or marginal ulcers.

Candidates include patients with inadequate weight loss after bypass, weight regain, metabolic disease recurrence, severe dumping syndrome, marginal ulcers, or complications related to the gastric pouch or gastrojejunostomy.

The procedure is performed laparoscopically. The gastric bypass is reversed, the stomach is reshaped into a sleeve, and the duodenum is connected to the ileum in a single‑anastomosis configuration. Most patients stay one night in the hospital.

Risks include bleeding, leak, stricture, nutritional deficiencies, diarrhea, bile reflux, and weight regain if long‑term habits are not maintained. Revisional surgery carries higher complexity due to scar tissue and altered anatomy.

Days 1–3: hydration, ambulation, pain control. Week 1: liquids. Week 2: soft foods. Weeks 3–4: gradual return to normal routines. By 30 days: improved energy, reduced hunger, and early metabolic improvements.

Patients typically experience stronger metabolic improvement and more durable fat loss compared to gastric bypass alone. Weight loss occurs steadily over 12–18 months.

Dr. Nestor de la Cruz‑Muñoz is a national leader in complex revisional bariatric surgery, including bypass reversal and advanced metabolic procedures such as SADI‑S. His expertise ensures safe reconstruction and optimal long‑term outcomes.

Most patients lose 22–30% of total body weight (TBWL) over 12–18 months after conversion. Results depend on adherence to nutrition, activity, and follow‑up.

SADI‑S conversion offers powerful improvement in type 2 diabetes, insulin resistance, hypertension, dyslipidemia, sleep apnea, and fatty liver disease.

Long‑term success requires protein‑forward nutrition, resistance training, avoiding slider foods, maintaining muscle mass, and consistent metabolic follow‑up. Body composition monitoring is essential.

SADI‑S may improve reflux in some patients but may worsen it in others. Patients with severe GERD may benefit more from RYGB revision rather than reversal. Hiatal hernia repair is performed when needed.

Future revision options include limb length adjustments, sleeve tightening, or conversion to full duodenal switch (DS) for maximal metabolic effect.

Preserving lean mass is essential for long‑term success. Patients are guided to prioritize protein intake, resistance training, hydration, and body composition monitoring.

Insurance coverage varies. Documentation of inadequate weight loss, metabolic disease, or bypass‑related complications may be required.

Pre‑op requirements may include bloodwork, imaging, endoscopy, nutrition consultation, psychological evaluation, and medication adjustments.

Nutrition progresses from clear liquids to full liquids, purees, soft foods, and then regular textures. Protein goals and vitamin supplementation are essential.

Early walking begins immediately after surgery. Light activity continues through week 2. Resistance training typically begins at week 4–6.

Miami is a major hub for patients from Latin America and the Caribbean. Our team supports travel coordination, virtual follow‑up, and streamlined pre‑op evaluation.