Single Anastomosis Duodenal Switch (SADI-S)

  • Adriana Ruano
  • Cristina Sánchez-del-Pueblo
  • Andrés Sánchez-Pernaute
  • Antonio Torres


Laparoscopic single-anastomosis duodenal switch or SADI-S (single-anastomosis duodeno-ileal bypass with sleeve gastrectomy) was first described in 2007 with the intention of simplifying a complex surgical technique, the biliopancreatic diversion with duodenal switch (BPD-DS).

From May 2007 to April 2017, 239 patients have been consecutively submitted to SADI-S. Thirty-three patients were submitted to SADI after a failed sleeve, 3 after a failed vertical banded gastroplasty, and 3 were converted from a failed gastric bypass.

Surgical times ranged from 210 to 75 min, with a mean time of between 90 and 120 min. The mean age of the patients was 47 years (22–71), with a mean weight of 119 kg and a mean BMI of 44.6 kg/m2. Sixty percent of patients presented type 2 diabetes or had insulin resistance; among them 40% were receiving insulin treatment and had a mean duration of the disease of 9.8 years.

Anastomotic leakage has presented in 1.9% of the patients. Peritoneal bleeding has occurred in one case and gastric bleeding in another patient who was endoscopically treated.

Long-term complications are usually nutritional issues. In the first series of patients with a 200 cm common limb, four patients had to be revised to a longer common channel for recurrent undernutrition and diarrhoea. In the second series with a 250 cm common channel and sometimes 300 cm (aged patients, low BMI), this initial 8% revisional rate has decreased to 2.5%. Dietary counselling and micronutrient supplementation are necessary to warrant an adequate outcome.


Duodenal switch Single-anastomosis duodenal switch Biliopancreatic diversion Metabolic surgery 

Supplementary material

Video 14.1

SADI-S step by step (MP4 1430933 kb)


  1. 1.
    Sanchez-Pernaute A, Rubio Herrera MA, Perez-Aguirre E, Garcia Perez JC, Cabrerizo L, Diez Valladares L. Proximal duodenal-ileal end-to-side bypass with sleeve gastrectomy: proposed technique. Obes Surg. 2007;17(12):1614–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Sanchez-Pernaute A, Rubio MA, Perez Aguirre E, Barabash A, Cabrerizo L, Torres A. Single-anastomosis duodenoileal bypass with sleeve gastrectomy: metabolic improvement and weight loss in first 100 patients. Surg Obes Relat Dis. 2013;9(5):731–5.CrossRefPubMedGoogle Scholar
  3. 3.
    Sanchez-Pernaute A, Rubio MA, Cabrerizo L, Ramos-Levi A, Perez-Aguirre E, Torres A. Single-anastomosis duodenoileal by- pass with sleeve gastrectomy (SADI-S) for obese diabetic patients. Surg Obes Relat Dis. 2015;11(5):1092–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Marceau P, Biron S, Marceau S, et al. Long-term metabolic outcomes 5 to 20 years after biliopancreatic diversion. Obes Surg. 2015;25(9):1584–93.CrossRefPubMedGoogle Scholar
  5. 5.
    Mitzman B, Cottam D, Goriparthi R, Cottam S, Zaveri H, Surve A, Roslin MS. Stomach intestinal pylorus sparing (SIPS) surgery for morbid obesity: retrospective analyses of our preliminary experience. Obes Surg. 2016;26(9):2098–104.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Adriana Ruano
    • 1
  • Cristina Sánchez-del-Pueblo
    • 1
  • Andrés Sánchez-Pernaute
    • 1
  • Antonio Torres
    • 1
  1. 1.Department of SurgeryClinico San CarlosMadridSpain

Personalised recommendations