OAGB to SADI conversion is a revisional bariatric procedure performed for patients experiencing bile reflux, weight regain, inadequate weight loss, metabolic failure, marginal ulcer, dumping, hypoglycemia, or complications from the original OAGB. The procedure removes the loop bypass configuration, creates or revises a sleeve gastrectomy, and connects the duodenum to the ileum in a single‑anastomosis configuration. SADI‑S provides powerful metabolic improvement and durable long‑term weight regulation.

The OAGB loop is taken down, the gastric pouch is reshaped into a sleeve if needed, and the duodenum is divided just beyond the pylorus. The ileum is brought up and connected to the duodenum in a single‑anastomosis configuration. This reduces calorie absorption, improves metabolic signaling, and eliminates bile reflux exposure.

Benefits include powerful metabolic improvement, strong appetite suppression, durable long‑term weight loss, elimination of bile reflux, reduced dumping, improved glycemic control, and more predictable nutrient absorption compared to OAGB.

Candidates include patients with bile reflux, weight regain, inadequate weight loss, metabolic failure, marginal ulcer, dumping, reactive hypoglycemia, malnutrition, or complications from the original OAGB. Patients seeking stronger metabolic effect or improved symptom control are also candidates.

The procedure is performed laparoscopically. The OAGB loop is taken down, the stomach is shaped into a sleeve, and the duodenum is divided. The ileum is connected to the duodenum in a single‑anastomosis configuration. Limb lengths are tailored to metabolic needs. Most patients go home the next day.

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

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 strong metabolic improvement and steady fat loss over 12–18 months. Long‑term results are more durable than restrictive procedures alone.

Dr. Nestor de la Cruz‑Muñoz is a nationally recognized bariatric and metabolic surgeon with extensive experience in complex revisional surgery and advanced metabolic procedures such as SADI‑S. His expertise ensures safe OAGB takedown and precise duodenal switch reconstruction.

Most patients lose 22–28% of total body weight (TBWL) over 12–18 months when weight regain was present.

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

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 to prevent metabolic slowdown.

SADI‑S may improve reflux in some patients but may worsen it in others. Patients with severe GERD or esophagitis may benefit more from conversion to gastric bypass. 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 to protect metabolic rate.

Most insurers cover revisional surgery when medical necessity is documented, including bile reflux, metabolic failure, or inadequate weight loss. Requirements may include imaging, endoscopy, and medical clearance.

Pre‑op requirements may include bloodwork, imaging, endoscopy, nutrition consultation, psychological evaluation, and medication adjustments. High‑risk patients may require additional testing.

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

Early walking begins immediately after surgery. Light activity continues through week 2. Resistance training typically begins at week 4–6 to support muscle preservation and metabolic health.

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 for international patients.