SASI procedure advantages disadvantages complications and post operative advice

Do you struggle with obesity or diabetes and are looking for an effective solution? The SADI-S procedure, also known as the Single Anastomosis Duodeno-Ileal Switch or “dual-loop” surgery, has become one of the latest bariatric surgeries. It combines significant weight loss with improvement in diabetes while reducing nutritional complications compared to some other procedures. In this article from Dalily Medical, we will explain the advantages of the SADI-S surgery, its potential drawbacks and risks, as well as essential pre- and post-operative tips—so you can be fully prepared to make the right decision and achieve the best results for your health and daily life.

What is the SADI-S (SASI) Surgery?

SASI surgery, also known as the Single Anastomosis Sleeve Ileal Bypass or “dual-loop” procedure, is one of the latest bariatric surgeries designed to treat severe obesity. It is considered revolutionary because it combines sleeve gastrectomy with a partial gastric bypass, aiming to maximize the benefits of both procedures while minimizing their complications.

The procedure was introduced in 2010 and is still under study to assess its long-term outcomes. SASI stands for Single Anastomosis Sleeve Ileal Bypass, which involves connecting the small intestine to the stomach after the sleeve gastrectomy.

How Does the Surgery Work?

It is sometimes called a “dual-path” surgery because it creates two pathways for food:

The natural path: Through the sleeve portion of the stomach, which reduces stomach size.
The bypass path: Through the diverted segment of the small intestine, which reduces the absorption of fats and sugars.

This combination allows significant weight loss, improves diabetes and obesity-related complications, and reduces the lifelong need for vitamin supplements compared to traditional gastric bypass surgeries.

Duration of the Surgery

SASI surgery usually takes 2 to 4 hours, depending on the patient’s condition, and may take longer if there are complications or other chronic diseases.

Main Difference Between SASI and Sleeve Gastrectomy

Sleeve Gastrectomy only: Restrictive procedure that reduces stomach size only.
SASI Surgery: Dual procedure (restrictive + malabsorptive), reducing stomach size while partially bypassing the small intestine. This makes it more effective for weight loss and diabetes management.

Expected Weight Loss

Most patients lose 70% to 85% of excess weight within 12 to 18 months post-surgery.

In the first three months, around 50% of excess weight can be lost.
Weight loss continues gradually until reaching the target weight after approximately 18 months.

Will I Need Supplements After Surgery?

Yes. Like most bypass procedures, lifelong vitamin and mineral supplementation is required, especially:

Vitamin B12
Iron
Calcium

However, SASI significantly reduces the risk of deficiencies compared to traditional gastric bypass.

Recovery and Returning to Work

Recovery: Fast due to laparoscopic technique.
Return to light office work: 10–14 days.
Full physical activity: Around 6 weeks.

Is SASI Reversible?

The sleeve portion is permanent.
The intestinal connection can be partially reversed if medically necessary, which is an advantage not offered by all bariatric surgeries.

Can Weight Regain Occur?

Yes, if dietary guidelines and medical follow-up are not strictly followed. Continuous monitoring with a medical and nutritional team is essential for long-term success.

Is SASI Surgery Safe?

Like any surgery, SASI carries some risks but is relatively safe when performed by an experienced surgeon. Potential risks include:

Infection at the surgical site
Leakage from the intestinal connection
Malabsorption (intended to reduce calorie and fat absorption)

Regular supplementation of vitamins, minerals, and protein is crucial to prevent nutritional deficiencies. Some patients may experience loose stools, bloating, or abdominal cramps due to fat malabsorption, which is partly expected.

Expected Weight Loss After SASI Surgery

70% to 90% of excess weight within 12–18 months post-surgery.
Results vary depending on adherence to diet, physical activity, and individual health conditions.
SASI not only helps with weight loss but also improves hormonal balance and appetite regulation long-term.

Weight Loss Timeline After SASI

Time After Surgery	Expected Weight Loss	Notes
Week 1–2	2–5 kg	Rapid loss due to fluids and reduced solid food intake
Month 1	Additional 5–10 kg	Transition to pureed foods and full liquids
Month 3	10–20 kg	Significant improvement in activity and diabetes control
Month 6	20–35 kg	Noticeable weight loss with improvement in comorbidities
Year 1	30–50 kg	Maximum weight loss achieved within the first year
Year 2+	Stabilization	Maintaining weight requires adherence to diet and exercise

Steps of SASI Surgery in the Operating Room

SASI is performed under general anesthesia and usually takes 2–3 hours. The procedure is mostly laparoscopic, using 5–6 small incisions (around 1 cm each).

Step-by-Step Procedure:

Anesthesia and Sterilization:
- Patient receives general anesthesia.
- Abdominal area is sterilized to prevent infection.
Inflating the Abdomen & Inserting the Laparoscope:
- 5–6 small incisions are made.
- Abdomen is inflated with CO₂ gas for better visibility.
- Camera and surgical instruments are inserted.
Stage 1: Sleeve Gastrectomy:
- A surgical stapler is used to cut the stomach longitudinally.
- 70–80% of the stomach is removed, mainly the portion producing the hunger hormone.
- The remaining stomach is a narrow tube with a capacity of 100–150 ml.
Stage 2: Intestinal Bypass:
- The surgeon identifies a point in the ileum approximately 250–300 cm from its end.
- A connection is created between the remaining stomach and this section of the small intestine, allowing partial bypass.

This combination provides effective weight loss, improved diabetes control, and better long-term metabolic results.

I can also translate the pre- and post-operative care, risks, and dietary instructions for SASI surgery into English if you want me to continue. Do you want me to do thats

Final Steps and Completion of SASI Surgery

After the main procedure, a leak test is performed using a special dye to ensure there are no leaks from the staple lines or the new intestinal connection.

Surgical instruments are removed, and the small incisions are closed with cosmetic sutures to minimize scarring.

⚠️ Risks and Considerations of SASI Surgery

SASI is relatively safe, but like any surgery, there are potential risks:

Vitamin and mineral deficiencies: Lifelong monitoring and supplementation may be required.
Leakage or infection: Risk at the connection between the stomach and small intestine.
Digestive issues: Some patients may experience diarrhea or fat malabsorption.

✅ Preoperative Steps for SASI Surgery

Before any bariatric surgery, several steps ensure safety and success:

1️⃣ Comprehensive Medical Evaluation

Medical history: Chronic diseases like diabetes, hypertension, heart, or liver problems.
Physical examination: Weight, BMI, gastrointestinal assessment.
Blood tests: Liver/kidney function, complete blood count, glucose, and lipid levels.
Coagulation tests: Ensure no bleeding risk during surgery.

2️⃣ Imaging and Endoscopic Exams

CT Scan/X-ray: Assess stomach and intestines.
Gastroscopy: Check for ulcers, inflammation, or tumors.
Sometimes a barium swallow is done to evaluate anatomy.

3️⃣ Nutritional and Dietary Assessment

Consultation with a dietitian to plan preoperative diet.
Low-fat, low-carb diet may be recommended to reduce liver size for better surgical access.

4️⃣ Psychological Assessment

Consultation with a psychologist or behavioral specialist.
Focus on readiness to follow post-op diet, exercise, and medical instructions.

5️⃣ Medication Adjustment and Preoperative Preparation

Stop blood-thinning medications as instructed.
Adjust diabetes medications if needed.
Fasting for 6–8 hours before surgery to prevent anesthesia complications.

6️⃣ Preoperative Instructions

Shower with antiseptic.
Wear hospital-provided surgical clothing.
Have a companion for pre- and post-surgery support.

✅ Who is Eligible for SASI Surgery?

SASI is not suitable for everyone. Eligibility is based on:

1️⃣ BMI (Body Mass Index)

Usually recommended for BMI ≥ 35 with obesity-related health issues.
Sometimes for BMI ≥ 40 even without other conditions.

2️⃣ Obesity-related Health Problems

Type 2 diabetes requiring improvement.
Hypertension, heart disease, sleep apnea.
High triglycerides or cholesterol resistant to medications.

3️⃣ Failed Previous Weight Loss Attempts

Patients who could not lose weight through diet and exercise.

4️⃣ Psychological Readiness

Ability to adhere to diet, exercise, and follow-up.
Assessment for eating disorders or mental health issues.

5️⃣ Comprehensive Medical Evaluation

Heart, lung, liver, kidney assessment.
Complete blood work.
Gastroscopy or imaging to rule out GI problems.

⚠️ Contraindications for SASI Surgery

Severe heart or lung problems making anesthesia risky.
Gastrointestinal issues preventing stomach-intestine connection (e.g., obstructions or severe inflammation).
Poor adherence to diet or follow-up.

✅ Advantages of SASI (Dual-Loop) Surgery

1️⃣ Significant weight loss – Reduces stomach size and calorie absorption.
2️⃣ Improves type 2 diabetes – Partial bypass helps regulate insulin and blood sugar.
3️⃣ Partial nutrient absorption preserved – Better than full bypass for vitamins and minerals.
4️⃣ Simpler than some other bypass surgeries – Only one connection needed.
5️⃣ Improves obesity-related conditions – Hypertension, triglycerides, sleep apnea.
6️⃣ Faster recovery – Shorter hospital stay.
7️⃣ Enhanced quality of life – Increased energy, mobility, and self-confidence.

✅ Postoperative Diet After SASI

Phase 1: Week 1 (Clear Liquids)

Allowed: water, clear broth, sugar-free gelatin, herbal tea, diluted honey water.
Avoid: caffeinated, sugary, or carbonated drinks.

Phase 2: Week 2 (Full Liquids)

Allowed: skim milk, blended soups, diluted natural juices, protein supplements.
Avoid: carbonated or sugary drinks, high-fat liquids.

Phase 3: Week 3 (Pureed Foods)

Allowed: mashed potatoes, low-fat yogurt, soft eggs, finely minced chicken or fish, well-cooked vegetables.
Avoid: fatty, spicy, or sugary foods.

Phase 4: Weeks 4–6 (Soft Foods)

Allowed: well-cooked white meats, soft fruits, cooked grains like oatmeal.
Avoid: very hard foods, nuts, fresh bread.

Phase 5: After Week 8 (Gradual Return to Regular Diet)

Allowed: balanced diet with protein, complex carbs, vegetables.
Avoid: high-fat, sugary, or empty-calorie foods.

✅ Mini Gastric Bypass vs SASI

Feature	Mini Gastric Bypass	SASI (Dual-Loop)
Surgical method	Small pouch connected to small intestine, bypassing part of stomach/intestine	Sleeve gastrectomy then connection to distal small intestine, preserving digestive flow
Number of connections	One	One, but digestive juices flow partially to preserve absorption
Weight loss	Very effective	Very effective, combines weight loss with improved diabetes
Diabetes control	Improved	Often better due to combined sleeve and partial bypass
Malabsorption	Higher, lifelong supplements needed	Less, preserves some nutrient absorption
Complexity	Simpler, shorter surgery	Slightly more complex due to sleeve + partial bypass
Ideal candidates	Patients wanting rapid weight loss and simpler surgery	Patients with obesity ± diabetes, aiming for weight loss + diabetes improvement with fewer malabsorption issues

⚠️ Possible Complications After SASI

1️⃣ Bleeding – Internal bleeding from vessels during surgery.
2️⃣ Leak at the stomach-intestine connection – Signs include severe pain, fever, or abnormal fluid.
3️⃣ Infection – At incision or inside abdomen.
4️⃣ Diarrhea or malabsorption – Fat malabsorption or vitamin deficiencies.
5️⃣ Vitamin/mineral deficiencies – Iron, B12, calcium, vitamin D.
6️⃣ Gallstones – Due to rapid weight loss.
7️⃣ Anesthesia-related risks – Blood pressure, heart, or lung issues.

⚠️ Disadvantages of SASI

1️⃣ Surgical complications – Bleeding, infection, leaks (rare with experienced surgeons).
2️⃣ Malabsorption – Some nutrient deficiencies may occur, requiring lifelong supplements.
3️⃣ Changes in bowel habits – Diarrhea or bloating early post-op.
4️⃣ Gallstones – More likely with rapid weight loss.
5️⃣ Psychological/social impact – Rapid body changes may affect mental health.
6️⃣ Strict adherence required – Diet, supplements, and regular check-ups.
7️⃣ Cost – May be higher than some other bariatric surgeries.

✅ Recovery Timeline After SASI

First 24–48 hours (Hospital)

Close monitoring of vital signs.
Light walking to prevent blood clots.
Leak test before starting fluids.
Mild pain controlled with medication.

Week 1 (Home)

Discharge usually 3–4 days post-op.
Clear liquid diet.
Light walking several times per day.

Weeks 2–3 (Pureed Food Phase)

Gradual transition to full liquids, then pureed foods.
Energy and comfort improve.

Weeks 4–6 (Soft Food Phase)

Introduce soft foods like boiled eggs, fish, cooked vegetables.
Eat slowly and chew thoroughly.

After 6 weeks (Regular Food)

Gradual return to solid foods, focusing on protein.
Resume exercise and full physical activity.

✅ Physical Activity

Light walking from day 1 to prevent clots and aid digestion.
Avoid heavy lifting or intense exercise for 4–6 weeks.

✅ Medical Follow-Up

Regular visits for weight loss, blood sugar, blood pressure, and labs.
Monitor vitamins/minerals to prevent deficiencies.

✅ Psychological and Social Adjustment

Rapid weight loss may affect mood and social life.
Psychological support helps adapt to lifestyle changes.

✅ Expected Results and Timeline

1️⃣ Diabetes improvement – Often immediate; some patients reduce or stop medications.
2️⃣ Weight loss – Rapid in first 3 months, reaching 70–85% of excess weight in 12–18 months.
3️⃣ Improvement of comorbidities – Blood pressure, cholesterol, sleep apnea, heart risk.
4️⃣ Better quality of life – Increased energy, mobility, self-confidence, and appearance.

✅ Maintaining Results for Life

Protein first: Include high-quality protein in every meal.
Hydration: ~2 liters/day; avoid drinking during meals (30 min before/after).
Supplements: Follow lifelong prescribed vitamins/minerals (B12, iron, calcium).
Avoid sugar and soda: Prevent dumping syndrome and weight regain.
Eat slowly and chew well: Signal fullness and protect the new stomach.
Regular exercise: Maintain metabolism and build muscle.
Routine follow-up: Blood tests every 6 months, then yearly.
Psychological support: Adjust relationship with food and new lifestyle.
Avoid smoking: Reduces risk of ulcers.
Adequate sleep: Supports metabolism and healthy weight loss.

⚠️ Potential Side Effects After SASI

Leakage: From staple line or intestinal connection; early detection and experienced surgeon reduce risk.
Blood clots (DVT): Prevented by early walking and anticoagulants if needed.
Malnutrition/vitamin deficiency: Prevented with supplements.
Dumping syndrome: Less severe than classic bypass.
Gallstones: Due to rapid weight loss; preventive medications may be used.
Changes in bowel movements: Diarrhea or fatty stools, often improving over time.