SADI-S: The Single-Anastomosis Procedure Gaining Ground in Colombia

If you have researched bariatric surgery beyond the sleeve-versus-bypass decision, you may have encountered a third option: SADI-S. The acronym stands for single-anastomosis duodenal-ileal bypass with sleeve gastrectomy. It is a hybrid procedure that combines the restriction of a sleeve with the malabsorption of a bypass, but with a simpler surgical anatomy than the traditional Roux-en-Y configuration.

SADI-S is not new -- it was first described in 2007 and has been performed routinely at high-volume centres for over a decade. But its availability in Colombia has expanded meaningfully in the past three years as more Colombian bariatric surgeons complete fellowship training in advanced metabolic procedures. It is now a realistic option for patients at centres in Bogotá and Medellín that handle complex bariatric cases.

How SADI-S differs from bypass and sleeve

Understanding SADI-S requires understanding what it borrows from each existing procedure. The first step is a standard sleeve gastrectomy -- the stomach is reduced to a narrow tube, just as in a standalone sleeve. The second step is where it diverges: the duodenum (the first segment of the small intestine) is divided just past the stomach, and the lower portion of the small intestine is connected directly to the duodenum in a single loop.

In a traditional Roux-en-Y gastric bypass, there are two intestinal connections (anastomoses). In SADI-S, there is one. This single-anastomosis design simplifies the anatomy, reduces operative time, and eliminates the risk of internal hernias that can occur between the two loops in a Roux-en-Y configuration.

Who SADI-S is for

SADI-S occupies a specific niche. It is typically recommended in three scenarios: patients with super-obesity (BMI above 50) where maximum weight loss effect is needed; patients with severe or difficult-to-control type 2 diabetes where maximum metabolic effect is desired; and patients undergoing revision surgery after a prior sleeve gastrectomy that produced insufficient weight loss or inadequate diabetes control.

For most first-time bariatric patients with BMI 35-45 and straightforward metabolic profiles, sleeve gastrectomy or standard bypass remains the recommended approach. SADI-S adds meaningful benefit in complex cases but carries higher nutritional risk that must be managed with rigorous lifelong supplementation.

Availability in Colombia

SADI-S requires advanced laparoscopic expertise and is not performed at every bariatric centre. In Colombia, it is available at select high-volume centres in Bogotá and Medellín where bariatric surgeons with specific training in complex metabolic procedures operate. When evaluating a centre for SADI-S, ask about the surgeon's specific SADI-S case volume (not just their total bariatric volume), their complication and revision rates for the procedure, and their post-operative nutritional monitoring protocol.

Pricing for SADI-S in Colombia typically runs $7,000 to $12,000 (typical 2026 ranges), compared to $20,000 to $35,000 in the US. The higher cost compared to sleeve alone reflects the longer operative time and greater technical complexity.

For the full picture of bariatric options, see the complete Colombia bariatric guide. For the sleeve-versus-bypass decision that precedes the SADI-S conversation, the sleeve vs bypass article covers the standard decision framework.

SADI-S is not a better version of bypass -- it is a different tool for different problems. For patients with super-obesity, refractory diabetes, or insufficient results from a prior sleeve, it offers the strongest metabolic intervention in the bariatric toolkit. The trade-off is a lifelong commitment to supplementation that cannot be negotiated.