Bariatric Surgery

SADI-S Surgery in Orlando

SADI-S, formally called Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy, is a weight loss procedure that combines a sleeve gastrectomy with a single intestinal bypass connection. The procedure produces some of the strongest weight loss and Type 2 diabetes remission rates of any bariatric surgery, and is typically recommended for patients with very high BMI (often 50 or above) or severe metabolic disease. SADI-S requires lifelong vitamin and mineral supplementation because of the malabsorptive component.

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On this page
  1. 01What Is SADI-S Surgery?
  2. 02SADI-S vs. Gastric Bypass
  3. 03Who Qualifies for SADI-S?
  4. 04Surgery and Recovery
  5. 05Long-Term Results and Lifelong Nutrition
  6. 06Cost, Insurance, and Financing
  7. 07Frequently Asked Questions

Procedure overview

What Is SADI-S Surgery?

SADI-S is a relatively newer bariatric procedure that builds on the older biliopancreatic diversion with duodenal switch (BPD-DS). The key change is that SADI-S uses a single intestinal connection (anastomosis) instead of the two connections required by BPD-DS, which makes the operation shorter and reduces certain complication risks while preserving most of the metabolic benefit. The procedure combines a sleeve gastrectomy with this single intestinal bypass, and the result is both restriction (the small sleeved stomach) and significant malabsorption (the bypassed segment of small intestine).

How SADI-S combines a sleeve and a duodenal switch

SADI-S assists weight loss in two ways. First, the sleeve gastrectomy component removes 75 to 85 percent of the stomach, leaving a narrow sleeve that limits how much food a patient can eat at one time. Second, the single intestinal bypass — the duodenum is divided just below the stomach and connected to a downstream loop of the small intestine — significantly reduces calorie and nutrient absorption. The duodenal-ileal connection is the single anastomosis the procedure is named for.

The hormonal effects of SADI-S are stronger than sleeve gastrectomy alone because the intestinal bypass alters GLP-1 and other gut hormone levels in addition to the ghrelin reduction from the sleeve. The metabolic effect is one of the reasons SADI-S has stronger published Type 2 diabetes remission rates than other primary bariatric procedures.

Why we offer laparoscopic and robotic SADI-S

Our bariatric surgery program performs SADI-S using two surgical techniques: laparoscopy, and with robotic assistance using the da Vinci system.

Laparoscopic

Laparoscopic surgery uses four to six small incisions and a camera to guide the procedure.

Robotic-assisted (da Vinci)

The duodenal-ileal connection sits deep in the abdomen and is technically demanding to construct, which is one reason Dr. Chetan Patel often uses the robotic approach for SADI-S — the magnified three-dimensional view and finer instrument movement help in the tight working space.

For most patients, both approaches produce equivalent outcomes.

Procedure comparison

SADI-S vs. gastric bypass — when each is the better choice

Both procedures produce strong weight loss and high rates of Type 2 diabetes remission, but they suit different patients.

SADI-S

Sleeve + single intestinal bypass

Mechanism
Sleeve gastrectomy combined with a single duodenal-ileal anastomosis. Restriction plus significant malabsorption.
Excess weight loss at 12 mo
75–90%
Long-term weight loss
80–100% of excess weight
Type 2 diabetes remission
70–90% at 2 years
Severe GERD
Can worsen reflux — sleeve component is the same mechanical concern
Operating time
120–180 minutes
Intestinal anastomoses
One (duodenal-ileal)
Supplementation burden
Aggressive lifelong — A, D, E, K plus calcium, iron, B12, full bariatric multivitamin
Long-term outcome data
Strong at 5–10 years; smaller cohorts than older procedures
Best fit
BMI >50, severe Type 2 diabetes, willing to commit to fat-soluble vitamin supplementation

Gastric Bypass

Pouch + Roux-en-Y bypass

Mechanism
Small pouch connected to a downstream loop of small intestine via a Roux-en-Y configuration. Restriction plus mild malabsorption.
Excess weight loss at 12 mo
65–80%
Long-term weight loss
60–75% of excess weight
Type 2 diabetes remission
60–85% at 2 years
Severe GERD
Often resolves — small pouch produces very little acid
Operating time
90–150 minutes
Intestinal anastomoses
Two (Roux-en-Y)
Supplementation burden
Standard lifelong — multivitamin, calcium, vitamin D, iron, B12
Long-term outcome data
Mature, multi-decade outcome data
Best fit
Severe GERD, BMI 35–50, prefers less malabsorptive procedure

Read the full clinical write-up

Lead-in plus four detailed sub-sections

Both SADI-S and gastric bypass produce strong weight loss and high rates of Type 2 diabetes remission, but they suit different patients. SADI-S is more malabsorptive and produces greater weight loss in patients with very high BMI. Gastric bypass is more restrictive and is typically recommended for patients with severe reflux. We evaluate both options with every candidate and recommend the procedure that best fits the patient's anatomy, metabolic disease, and goals.

How the two procedures differ mechanically

While gastric bypass creates a small pouch and reroutes the small intestine using two anastomoses (a Roux-en-Y configuration), SADI-S keeps the existing stomach as a sleeve and uses one intestinal anastomosis. The malabsorptive segment in SADI-S is longer than in gastric bypass, which is the main reason SADI-S produces greater weight loss in very high-BMI patients but also requires more aggressive lifelong supplementation.

Weight loss and diabetes outcomes by procedure

Published data from major bariatric centers show SADI-S producing greater long-term weight loss than gastric bypass, particularly in patients who began with a BMI above 50. Type 2 diabetes remission rates are also high, comparable to or somewhat better than gastric bypass at two years. Long-term outcome data for SADI-S continues to mature because the procedure is newer than sleeve or bypass — the longest follow-up studies currently extend to five and ten years, where outcomes hold strong but the sample sizes are smaller than for the older procedures.

When we typically recommend each

For patients with a BMI above 50, severe Type 2 diabetes that has not responded to medication, or both, we more often recommend SADI-S — the greater weight loss and stronger metabolic effect justifies the additional supplementation commitment. For patients with significant pre-existing acid reflux, gastric bypass is the better choice. For patients in the BMI 35 to 50 range without severe metabolic disease, gastric bypass typically produces excellent outcomes with somewhat less supplementation burden. Dr. Patel walks through both options with every patient during the consultation.

Reflux considerations

SADI-S includes a sleeve gastrectomy component, which means patients with significant pre-existing acid reflux are typically not the best candidates for SADI-S. The same mechanical considerations that make gastric bypass the preferred procedure for severe GERD apply here — the sleeve component of SADI-S can worsen reflux. If reflux is a major concern, we recommend gastric bypass.

Candidacy

Who qualifies for SADI-S

SADI-S candidacy follows the standard ASMBS bariatric criteria but is more often used for patients at the higher end of the BMI range or with severe metabolic disease. We review each candidate individually before recommending the best weight loss strategy.

  • BMI of 50 or higher

    SADI-S is often the preferred primary procedure given the stronger weight loss outcomes at this BMI range.

  • BMI of 40 to 49.9

    SADI-S is one of three primary bariatric options. Sleeve and bypass are typically considered first; SADI-S may be recommended if Type 2 diabetes is severe or if the patient prefers the malabsorptive approach.

  • BMI of 35 to 39.9

    SADI-S is rarely the first-line procedure at this BMI range, but may be considered with severe diabetes or other significant metabolic disease.

Most insurance carriers approve SADI-S under the same general criteria as other primary bariatric procedures, though some plans have specific language for SADI-S that we verify before submitting pre-authorization.

Read the full clinical write-up

Candidacy lead-in, qualifying conditions, when we recommend a different procedure, and pre-surgery evaluation

SADI-S candidacy follows the standard ASMBS bariatric criteria but is more often used for patients at the higher end of the BMI range or with severe metabolic disease. We review each candidate individually before recommending the best weight loss strategy.

BMI thresholds (often targeted at BMI 50+)

There are three published BMI thresholds that can open SADI-S candidacy:

  • BMI of 50 or higher: SADI-S is often the preferred primary procedure given the stronger weight loss outcomes at this BMI range.
  • BMI of 40 to 49.9: SADI-S is one of three primary bariatric options. Sleeve and bypass are typically considered first; SADI-S may be recommended if Type 2 diabetes is severe or if the patient prefers the malabsorptive approach.
  • BMI of 35 to 39.9: SADI-S is rarely the first-line procedure at this BMI range, but may be considered with severe diabetes or other significant metabolic disease.

Most insurance carriers approve SADI-S under the same general criteria as other primary bariatric procedures, though some plans have specific language for SADI-S that we verify before submitting pre-authorization.

Conditions that often make SADI-S the better option

The most common reasons we recommend SADI-S over sleeve or bypass are very high BMI (50+), severe Type 2 diabetes that has not responded to medication or to less aggressive bariatric procedures, and a combination of high BMI with multiple metabolic conditions. For patients with severe diabetes specifically, the strong remission rates published for SADI-S are often what tips the recommendation.

Why we sometimes recommend a different procedure

SADI-S is not the right answer for every patient who qualifies for bariatric surgery. For instance, patients with significant pre-existing acid reflux are typically better served by gastric bypass. As another example, patients who are not committed to lifelong daily vitamin and mineral supplementation may do better with a less malabsorptive procedure where the supplementation requirements are lower. We will discuss the full range of options with you during your consultation.

The pre-surgery evaluation

Candidacy for SADI-S is based on more than BMI and comorbidity factors, so we also perform a full pre-operative workup before recommending surgery. We evaluate each candidate across clinical, nutritional, psychological, and insurance-related criteria:

  • Nutritional assessment with a registered dietitian to evaluate your readiness for the lifelong supplementation requirements SADI-S adds
  • Psychological evaluation to confirm you have realistic expectations and are emotionally prepared for the long-term commitment
  • Medical clearance from your primary care physician or an internist, including relevant lab work and imaging
  • Insurance requirements: Most plans require documentation of participation in a supervised medical weight management program (typically three to six months)

We coordinate the full evaluation and assist with insurance pre-authorization on your behalf.

Recovery

What recovery looks like

Most patients walk within hours of surgery and return to desk work in 2–3 weeks. Physical-labor jobs require 4–6 weeks off.

  1. Day of surgery

    In the OR — 120 to 180 minutes

    General anesthesia. 4 to 6 small incisions. Sleeve gastrectomy performed first (removing 75 to 85 percent of the stomach); duodenal-ileal anastomosis constructed second. Robotic-assisted via da Vinci for greater precision at the intestinal connection.

  2. Hospital stay · 1–2 nights

    Walking within hours

    Most patients begin walking within a few hours of surgery to support circulation. Clear liquids only during week 1.

  3. Weeks 2–4

    Diet advances, energy returns

    Full liquids in week 2; pureed foods in weeks 3–4. Most patients return to desk work by end of week 2. Lifelong supplementation begins as soon as tolerated.

  4. Weeks 5–6+

    Soft solids, then regular textures

    Soft solids in week 5; regular textured foods by week 6. Physical-labor jobs resume at 4–6 weeks. Structured exercise can resume once surgical sites have healed.

Read the full clinical write-up

Five detailed sub-sections — day of surgery through the post-SADI-S diet and supplement routine

The day of surgery

SADI-S is performed under general anesthesia. Dr. Patel will make four to six small incisions in the abdomen, insert a camera and surgical instruments, then perform the sleeve gastrectomy component first (removing 75 to 85 percent of the stomach) and the duodenal-ileal anastomosis second. For robotic-assisted procedures, the da Vinci system guides the same steps with greater precision at the intestinal connection. Total operating time is typically 120 to 180 minutes for an uncomplicated case — longer than sleeve or bypass because of the duodenal-ileal connection.

The first week: hospital and coming home

Most patients stay one to two nights in the hospital. Patients are encouraged to begin walking around within a few hours after surgery to support circulation and reduce the risk of blood clots. Most patients feel tired and sore for the first one to two weeks. Discomfort is manageable with prescribed pain medication and typically eases by the end of week one. Diet during the first week is clear liquids only.

Weeks 2–4: diet advances and energy returns

Most patients will notice their energy levels returning, and many can return to desk jobs by the end of week two. The diet advances through full liquids (week 2), pureed foods (weeks 3–4), and soft solids (week 5) before regular textured foods are reintroduced. Our dietitian provides individualized guidance at each stage. Protein intake is the priority throughout.

Returning to work and physical activity

While desk jobs can often be resumed within two to three weeks, jobs involving physical labor, lifting, or sustained standing require four to six weeks off. Light walking is encouraged from day one. Structured exercise typically resumes by four to six weeks once the surgical sites have healed. Dr. Patel will provide specific post-operative activity guidelines.

The post-SADI-S diet and supplement routine

The SADI-S post-surgery diet follows the same five-stage progression as other primary bariatric procedures (clear liquids → full liquids → pureed → soft → regular textured foods over six weeks). What's different from sleeve or bypass is the supplementation routine. SADI-S patients begin daily multivitamin, calcium, iron, and fat-soluble vitamin (A, D, E, K) supplementation as soon as they can tolerate it post-operatively, and continue all of it for life.

Long-term outcomes

Long-term results and lifelong nutrition

Published data from major bariatric centers and peer-reviewed studies show SADI-S producing some of the strongest weight loss and Type 2 diabetes remission rates of any bariatric procedure.

Weight loss expectations at 6, 12, and 24 months

65–80%

Excess weight loss

within first 6 months

75–90%

Excess weight loss

at 12 months

80–100%

Stable long-term

12 to 24 months and beyond

Published data from major bariatric centers and peer-reviewed studies show SADI-S producing 65 to 80 percent of excess body weight lost at 6 months, 75 to 90 percent at 12 months, and most patients reaching a stable long-term weight at 80 to 100 percent of excess body weight lost between 12 and 24 months. These ranges are higher than sleeve or bypass at the same time points, which is consistent with SADI-S's stronger published outcomes for high-BMI patients.

Diabetes and metabolic outcomes

SADI-S resolves Type 2 diabetes at one of the highest rates of any bariatric procedure. Published studies show complete diabetes remission in 70 to 90 percent of patients at two years post-surgery, with the highest rates seen in patients whose diabetes was less than ten years old at the time of surgery. SADI-S also resolves or substantially improves sleep apnea, high blood pressure, and other metabolic conditions at rates comparable to gastric bypass.

70–90%

Type 2 diabetes

Complete remission at 2 years post-surgery — highest rates in patients whose diabetes is less than 10 years old

Comparable

Other metabolic conditions

Sleep apnea, hypertension, and related metabolic conditions resolve or substantially improve at rates comparable to gastric bypass

The most important post-op commitment

Lifelong vitamin and mineral supplementation

Lifelong supplementation is the single most important commitment SADI-S patients make. Because the procedure bypasses a significant length of small intestine, fat-soluble vitamins (A, D, E, K) and certain minerals are not absorbed at normal rates. Standard daily supplementation includes:

  • Complete multivitamin designed for bariatric patients (Bariatric Advantage, Celebrate, ProCare Health, or comparable)
  • Calcium citrate 1,500 to 2,000 mg
  • Vitamin D3 3,000 to 5,000 IU
  • Iron (especially for menstruating patients)
  • Vitamin B12 (sublingual or monthly injection)
  • Fat-soluble vitamins A, D, E, K at higher doses than the standard multivitamin provides

Annual labs check for deficiencies and the regimen is adjusted as needed. This is a permanent commitment, not a temporary recovery measure.

If regain happens

When patients regain, and what we do about it

Some weight regain after the first two years is common across all bariatric procedures, including SADI-S. What matters is the degree and the trajectory. Patients who regain modestly and then stabilize are generally within the expected long-term pattern. Patients who regain significantly are evaluated for revisional bariatric surgery or adjunctive treatment.

Our program emphasizes continued follow-up care to help patients protect their results. Read our patient reviews to hear directly from patients who have completed the program.

SADI-S resolves Type 2 diabetes at one of the highest rates of any bariatric procedure — complete remission in 70 to 90 percent of patients at two years.
Published SADI-S outcomes data · Major bariatric centers, two-year follow-up

Cost & coverage

Cost, insurance, and financing in Florida

Three paths to coverage. We help every patient understand which applies before pre-authorization or self-pay paperwork begins.

Insurance coverage

Most major insurance carriers cover SADI-S when the ASMBS candidacy criteria are met. Some plans have specific SADI-S coverage language that differs from sleeve or bypass policy — we verify carrier coverage before submitting pre-authorization.

AetnaAnthem BCBSCignaUnitedHealthcareFlorida Blue

Standard documentation includes a physician referral, BMI records, a qualifying comorbidity when BMI is 35 to 39.9, and proof of participation in a medically supervised weight loss program (typically three to six months). We review insurance coverage for bariatric surgery with every patient.

Self-pay pricing in Orlando

$16,125–$24,400

U.S. market range

SADI-S in the United States typically runs from $16,125 to $24,400, depending on the provider, facility, and what's included in the package. SADI-S is generally more expensive than sleeve gastrectomy or gastric bypass because of the technical complexity of the duodenal-ileal anastomosis.

Before comparing prices, we recommend asking any provider for a clear itemization of what is and isn't included.

Financing through Cherry

For patients paying out-of-pocket, we offer Cherry financing options for qualified applicants.

Cherry runs payment plans with no prepayment penalty. Ask our patient coordinator about current terms and eligibility during your consultation.

Ask about financing

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At Orlando Minimally Invasive Surgery, we stay by your side throughout your surgical journey, ensuring you feel informed, supported, and cared for at every stage.

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Frequently asked questions about SADI-S surgery

  • How much does SADI-S surgery cost?

    SADI-S in the United States typically ranges from $16,125 to $24,400, depending on the provider, facility, and what the package includes. SADI-S is generally more expensive than sleeve gastrectomy or gastric bypass because of the technical complexity of the duodenal-ileal anastomosis. Insurance coverage is available for qualifying patients and substantially reduces out-of-pocket cost.

  • Who qualifies for SADI-S surgery?

    SADI-S candidates typically have a BMI of 40 or higher, or a BMI of 35 to 39.9 with at least one obesity-related condition such as Type 2 diabetes, severe sleep apnea, or hypertension. SADI-S is most often recommended for patients with a BMI of 50 or higher or for patients with severe Type 2 diabetes that has not responded to less aggressive treatments. ASMBS publishes the standard candidacy criteria.

  • What are the disadvantages of SADI-S surgery?

    The main long-term consideration with SADI-S is the lifelong vitamin and mineral supplementation requirement. The procedure bypasses a significant length of small intestine, which reduces absorption of fat-soluble vitamins (A, D, E, K), iron, calcium, and B12. Patients commit to a daily supplementation routine for life and to annual lab work to check for deficiencies. This is a real lifestyle commitment, not a footnote.

  • Is SADI-S better than gastric bypass?

    SADI-S often produces greater weight loss than gastric bypass, particularly in patients with very high BMI, and the published Type 2 diabetes remission rates are comparable to or slightly higher than bypass. Gastric bypass may be the better choice for patients with significant pre-existing acid reflux or for patients who prefer a less malabsorptive procedure. The right answer depends on the individual patient's clinical picture, not a universal rule.

  • What happens 10 years after a SADI-S procedure?

    Long-term SADI-S outcome data continues to mature because the procedure is newer than sleeve or bypass. Studies extending to five and ten years show weight loss results holding strong for most patients, with continued diabetes remission and metabolic improvement. Sample sizes are smaller than for older procedures, so the 10-year picture for SADI-S is less complete than for sleeve or gastric bypass. We tell every SADI-S patient honestly what we know and what we don't yet know.

  • What is the difference between SADI-S and gastric bypass?

    SADI-S combines a sleeve gastrectomy with a single intestinal bypass connection (the duodenal-ileal anastomosis). Gastric bypass creates a small stomach pouch and reroutes the small intestine using two connections (the Roux-en-Y configuration). SADI-S is more malabsorptive and produces greater weight loss in high-BMI patients. Gastric bypass is more restrictive and is typically recommended for patients with severe acid reflux.

  • What vitamin and mineral supplements do I need after SADI-S?

    SADI-S patients commit to daily lifelong supplementation that includes a complete bariatric multivitamin, calcium citrate (1,500 to 2,000 mg), vitamin D3 (3,000 to 5,000 IU), iron, vitamin B12 (sublingual or monthly injection), and fat-soluble vitamins A, D, E, and K at higher doses than the standard multivitamin provides. Annual labs check for deficiencies and the regimen is adjusted as needed.

  • Is SADI-S a robotic procedure?

    SADI-S can be performed laparoscopically or with robotic assistance using the da Vinci system. Dr. Patel often uses the robotic approach for SADI-S because the duodenal-ileal anastomosis sits deep in the abdomen and is technically demanding to construct — the magnified three-dimensional view and finer instrument movement help in the tight working space. For most patients, both approaches produce equivalent outcomes.

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