SADI‑S is a modern evolution of the duodenal switch designed to deliver powerful metabolic effects with a simplified operative approach. It combines sleeve gastrectomy with a single duodeno‑ileal anastomosis, producing high weight loss, strong diabetes remission, and lower nutritional risk than traditional DS.

SADI‑S works through reduced stomach volume, rapid nutrient delivery to the ileum, powerful incretin stimulation increasing GLP‑1 and PYY, bile acid pathway changes, and a single anastomosis that simplifies operative anatomy while maintaining strong malabsorptive effect.

Benefits include high long‑term weight loss, strong diabetes remission, reduced nutritional risk compared to traditional DS, lower operative complexity, single anastomosis reducing internal hernia risk, and powerful metabolic effect in patients with severe obesity.

You may be a candidate for SADI‑S if you have: BMI ≥ 40; BMI ≥ 35 with metabolic disease; prior sleeve gastrectomy with inadequate weight loss or metabolic response; severe type 2 diabetes; or preference for a powerful metabolic procedure with lower nutritional risk than DS.

SADI‑S is performed laparoscopically. First, a sleeve gastrectomy is created. The duodenum is divided and connected directly to a loop of ileum 250–300 cm from the ileocecal valve. This single connection creates powerful metabolic and malabsorptive effects.

Limb lengths are tailored to patient anatomy and metabolic needs. SADI‑S uses a 250–300 cm common channel, longer than traditional DS, reducing nutritional risk while maintaining strong metabolic effect.

Potential risks include bleeding, leak, stricture, bile reflux, nutritional deficiencies (vitamins A, D, E, K, B12, iron, calcium), diarrhea, and weight regain. Nutritional risk is lower than traditional DS but lifelong supplementation remains essential.

Days 1–3: hydration, gentle movement, pain control. Week 1: clear to full liquids. Week 2: soft foods. Weeks 3–4: transition to normal routines. By 30 days: improved energy, reduced hunger, early metabolic changes. Nutritional follow‑up begins immediately.

Patients typically experience durable long‑term fat loss, strong metabolic improvement, and high rates of comorbidity resolution. Lifelong vitamin supplementation and regular lab monitoring are essential to maintain results.

Dr. Nestor de la Cruz‑Muñoz is a nationally recognized bariatric and metabolic surgeon with outcomes that exceed national benchmarks. His high‑volume experience, advanced minimally invasive techniques, and long‑term metabolic support model ensure safe, effective, and compassionate care.

Most patients lose 35–41% of total body weight (TBWL) at 1 year. Long‑term success depends on protein‑forward nutrition, resistance training, consistent metabolic follow‑up, and mandatory lifelong supplementation.

SADI‑S produces powerful metabolic effects: increased GLP‑1 and PYY, improved insulin sensitivity, bile acid pathway shifts, and strong diabetes remission. Remission rates approach those of traditional DS with lower nutritional risk.

SADI‑S is preferred for patients with severe obesity or metabolic disease who want maximum metabolic effect with a simplified operative anatomy and reduced nutritional risk compared to DS.

Potential long‑term issues include vitamin deficiencies, diarrhea, bile reflux, and anastomotic complications. Lifelong supplementation, regular lab monitoring, protein‑first nutrition, and consistent metabolic follow‑up are essential to prevent complications.

Because SADI‑S includes a sleeve component, reflux may worsen in some patients. Patients with severe pre‑existing GERD should be evaluated carefully before proceeding with SADI‑S. The malabsorptive component may reduce symptoms in others.

SADI‑S is an excellent revisional option for sleeve gastrectomy with inadequate weight loss or metabolic response. It may be performed as a staged procedure after sleeve gastrectomy. SADI‑S itself may be revised by adjusting limb lengths or converting to DS if greater malabsorption is needed.

Sleeve success depends on preserving lean mass. Patients are guided to prioritize protein intake, resistance training, and adequate hydration. Maintaining muscle protects metabolism and reduces long-term weight regain risk.

Most insurers require documentation of BMI criteria, comorbidities, supervised weight‑loss attempts, and medical clearance. Our team handles verification and authorization.

Pre-op requirements may include a liver-shrinking diet, bloodwork, cardiac clearance, sleep apnea 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 are emphasized from day one. Hydration and vitamin supplementation are esse

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.