SADI-S Surgery in Darien & Bolingbrook
The Single-Anastomosis Duodeno-Ileal Bypass with Sleeve (SADI-S) is one of the most powerful weight-loss procedures available — combining a gastric sleeve with a single intestinal bypass. Performed robotically by Dr. El Djouzi, it delivers 80–90% excess weight loss and is especially effective for patients with BMI 50+ or severe metabolic disease.
What Is SADI-S?
SADI-S stands for Single-Anastomosis Duodeno-Ileal Bypass with Sleeve. It's a hybrid procedure that combines two proven techniques in a single operation: the restrictive component of a gastric sleeve, and the malabsorptive component of an intestinal bypass.
First, Dr. El Djouzi removes about 80% of the stomach to create a narrow tube — the same step performed in a standalone gastric sleeve. Then, instead of leaving the small intestine intact, the small intestine is divided just past the stomach (the duodenum) and reconnected to a loop of intestine roughly 250–300 cm downstream. This creates a single new connection (anastomosis) and bypasses a substantial portion of the small bowel.
The combined effect: the patient eats less because the stomach is smaller, absorbs fewer calories because food passes through less of the intestine, and experiences a powerful improvement in metabolic conditions like type 2 diabetes. SADI-S is sometimes referred to as a simpler, safer evolution of the older duodenal switch (BPD-DS).
Why patients and surgeons are choosing SADI-S
- Highest sustained weight loss of any commonly performed bariatric procedure (80–90% excess weight loss at five years).
- Excellent diabetes resolution rates — multiple studies report 80%+ of patients achieving complete remission within 12 months.
- Single anastomosis means only one new intestinal connection (vs. two in the older duodenal switch), reducing operative time and the risk of leaks or strictures.
- Robotic technique allows for precise dissection in the deep abdomen with smaller incisions and faster recovery than open surgery.
Who Is the Ideal Candidate?
SADI-S is more powerful than a sleeve or standard bypass, but it's not the right first choice for every patient. Dr. El Djouzi reserves it for cases where the additional weight loss and metabolic benefit are clearly indicated.
Good fit if you have
- BMI of 50 or higher
- Type 2 diabetes (especially insulin-dependent)
- Severe metabolic syndrome
- Failed weight loss after a previous gastric sleeve and need a revision
- Substantial weight to lose (more than 100 pounds)
- Commitment to lifelong vitamin and protein supplementation
- Reliable access to follow-up care every 3–6 months
SADI-S may not be right if
- Your BMI is under 40 with no major comorbidities — gastric sleeve or bypass is usually a better first step
- You have a history of severe inflammatory bowel disease
- You can't reliably take daily vitamins and attend regular follow-ups
- You have a complex history of multiple prior abdominal surgeries with extensive adhesions
- You have severe protein-calorie malnutrition risk factors
What to Expect: From Consult to Recovery
SADI-S vs. Sleeve vs. Bypass
Where SADI-S sits among the alternatives. Individual results vary; Dr. El Djouzi will recommend the right procedure for you during your consultation.
| Procedure | Avg. Excess Weight Loss | Diabetes Remission | Recovery | Vitamin Needs |
|---|---|---|---|---|
| Gastric Sleeve | 60–70% | ~60% | 2–4 weeks | Standard daily multi |
| Gastric Bypass | 70–80% | ~75% | 3–4 weeks | Multi + B12 + iron + calcium |
| SADI-S | 80–90% | 80%+ | 4–6 weeks | Multi + ADEK + B12 + iron + calcium |
Insurance & Cost
SADI-S is covered by most commercial insurance plans accepted by Premier Bariatric Institute when medical criteria are met. Because SADI-S is newer than sleeve or bypass, some insurers categorize it differently — we verify your specific coverage before discussing any out-of-pocket cost.
Plans we work with: BCBS Illinois, Aetna, UnitedHealthcare, Cigna, Humana, TriCare, and Medicare. Self-pay options are available for patients without coverage.
Typical insurance requirements for SADI-S coverage:
- Documented BMI of 35+ with severe comorbidity, or BMI 40+
- Supervised medical weight-loss attempts (length varies by carrier)
- Psychological evaluation
- Nutrition consultation
- For revision SADI-S after a prior sleeve: documentation of weight regain or inadequate loss
Our insurance team handles prior authorizations, peer-to-peer reviews, and appeals at no cost to you. See full insurance details →
Not sure if SADI-S is right for you?
Take our 1-minute eligibility quiz, or book a virtual consultation with Dr. El Djouzi. Most consultations happen within 48 hours — and your insurance is verified before you ever walk in.
SADI-S Frequently Asked Questions
How is SADI-S different from a duodenal switch (BPD-DS)?
The traditional duodenal switch creates two new intestinal connections (anastomoses), making it technically demanding and increasing the risk of leaks. SADI-S creates only one anastomosis, which simplifies the operation, shortens operative time, and reduces complication rates while preserving most of the weight-loss and metabolic benefit. Most surgeons and centers performing the duodenal switch today have transitioned to SADI-S as the standard variant.
How much weight will I lose with SADI-S?
Most SADI-S patients lose 80–90% of their excess body weight within 18–24 months. For someone who is 150 pounds above their ideal weight, that's 120–135 pounds lost. Long-term studies show this weight loss is durable at 5+ years when patients follow the nutrition and supplementation plan.
Will SADI-S resolve my type 2 diabetes?
SADI-S has one of the highest diabetes-remission rates of any bariatric procedure — over 80% of patients achieve complete remission within 12 months, often within days of surgery. This is because the rerouting of food past the duodenum triggers powerful hormonal changes that improve insulin sensitivity independent of weight loss. Patients on insulin frequently leave the hospital off insulin.
What are the risks of SADI-S?
The most important long-term consideration is nutritional. Because SADI-S bypasses a portion of the small intestine, patients must take fat-soluble vitamins (A, D, E, K), B12, iron, and calcium daily for life and attend regular blood-work follow-ups. Short-term surgical risks (leak, bleeding, infection, blood clots) are similar to other bariatric procedures and are very low at MBSAQIP-accredited centers like ours. Diarrhea and stool-frequency changes are more common after SADI-S than after sleeve or bypass.
Can I get SADI-S as a revision after a failed sleeve?
Yes — SADI-S is one of the most common revision options for patients who had a gastric sleeve and either didn't lose enough weight or regained significant weight. Dr. El Djouzi has performed many sleeve-to-SADI-S conversions. The existing sleeve is usually preserved, and only the intestinal bypass component is added. Insurance typically covers revision SADI-S when adequate weight loss wasn't achieved or returned weight is documented.
Is SADI-S reversible?
The sleeve portion of SADI-S permanently removes part of the stomach and is not reversible. The intestinal bypass portion is technically reversible by reconnecting the original anatomy, though this is rarely needed and is reserved for unusual circumstances such as severe protein malnutrition unresponsive to dietary intervention.
How long do I stay in the hospital after SADI-S?
Most SADI-S patients spend 2 nights in the hospital. The first night is for pain management and observation; the second is to confirm tolerance of clear liquids and ambulation. Discharge is to home; full recovery to work and exercise takes 4–6 weeks.
What vitamins will I need to take after SADI-S?
Daily lifelong supplementation includes: a high-potency bariatric multivitamin, calcium citrate (1,200–1,500 mg/day), vitamin D3 (3,000+ IU/day), vitamin B12 (sublingual or injection), iron (women), and fat-soluble vitamins A, D, E, and K. Lab work every 6 months for the first two years, then annually, allows us to fine-tune supplementation. This commitment is non-negotiable for SADI-S patients.
Ready to talk about SADI-S?
Schedule a virtual consultation with Dr. El Djouzi to discuss whether SADI-S is the right procedure for your weight-loss goals and medical history. Insurance verified before your first visit.