Single Anastomosis Duodenoileal Bypass with Sleeve Gastrectomy

Single anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) was introduced in Spain in May 2007 as a modification and simplification of the traditional biliopancreatic diversion with duodenal switch (DS). SADI-S is a one-loop duodenal switch in which the sleeve gastrectomy is performed over a wide bougie (54 French), the antrum of the stomach is partially preserved (section 5–6 cm from the pylorus) and the duodenum is anastomosed to the proximal ileum, with a variable length of the common alimentary limb from 250 to 300 cm. Duodenal dissection is ideally performed with preservation of the right gastric artery, to improve vascularization and avoid anastomotic problems. The duodeno-ileostomy can be hand sewn or mechanically performed, with an usual width of 2–3 cm.