Single Anastomosis Duodeo-Ileal Bypass with Sleeve Gastrectomy (SADI-S) or Single Anastomosis Duodeo-Jejunal Bypass with Sleeve Gastrectomy (SADJ-S).
These techniques arise as a fusion of the Sleeve Gastrectomy and those with a major malabsorptive component. As its name mentions in SADI-S, the bypass is made from the first part of the duodenum to the ileum (final part of the small bowel), while in the SADJ-S this is made to the jejunum (middle portion of the small bowel). As expected, the SADI-S generates greater weight loss. However, it confers a greater risk of malnutrition and deficiencies.
SADI-S is an excellent option for the management of those patients who have “failed” a previous bariatric procedure, and/or showed weight regain. Also, this is an excellent option in selected super-obese patients (BMI > 50 kg/m2).
On the other hand, SADJ-S has been recently described as an excellent alternative to Roux-en-Y Gastric Bypass or to the Mini-Gastric Bypass, showing excellent results in terms of weight loss and achieving near to 90% remission of Type 2 Diabetes.
The main advantage of these techniques consists in that these are pylorus sparing (pylorus preservation) procedures. This confers a lower risk of dumping, as well as, avoidance of biliary reflux that exists in the Mini-Gastric Bypass. Like the primary Sleeve Gastrectomy, neither of these 2 procedures are recommended in patients with history of GERD.