70 to 85 percent
Of excess weight lost
Five-year data holds near 73 percent. In total body terms that is 35 to 38 percent, the highest figures of any bariatric operation.
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216-377-7257 [email protected]Lyndhurst
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25200 Center Ridge Rd, Suite 1100Coming soon to Karas Weight Loss and Wellness. SADI-S is not yet available at the practice. Consultations are open now, and patients who qualify will be first scheduled when the program launches.
SADI-S produces more weight loss than any other bariatric operation, and almost nobody in Northeast Ohio offers it. That is about to change. Dr. Linden Karas is bringing SADI-S to Karas Weight Loss and Wellness, and patients who want to be evaluated can schedule consultations now, ahead of the launch.
What It Is
SADI-S stands for single anastomosis duodeno-ileal bypass with sleeve gastrectomy. You may also see it called the single-anastomosis duodenal switch, the loop duodenal switch, or SIPS. All the names describe the same operation in two parts.
Part one is a standard sleeve gastrectomy: about 80 percent of the stomach is removed, leaving a banana-shaped tube that restricts intake and lowers hunger hormones. Part two is where the power comes from. The first inch of intestine below the stomach is divided, and a loop of intestine from much further downstream is connected to it. Food then skips more than half the small intestine, so a meaningful share of calories, especially from fat, passes through without being absorbed.
One detail separates SADI-S from gastric bypass. The pylorus, the muscular valve that meters food out of the stomach, stays in place and keeps working. That preserved valve means food leaves the stomach at a controlled pace, which is why dumping syndrome is rare after SADI-S and why ulcers at the connection are less common too.
SADI-S is the modern refinement of the classic duodenal switch, delivering the same class of results with one intestinal connection instead of two. One connection means a shorter operation, one less place for a leak, and a gentler side effect profile. The American Society for Metabolic and Bariatric Surgery formally endorsed SADI-S in 2020.
Who It Is For
SADI-S earns its place in three situations:
Standard bariatric criteria apply as the floor: a BMI of 40 or higher, or 35 and up with a weight-related condition. SADI-S is a poor fit for patients with significant acid reflux, inflammatory bowel disease, or chronic diarrhea, and it demands a genuine lifelong commitment to vitamins and lab monitoring, more so than any other operation offered here.
The Operation
SADI-S is performed laparoscopically under general anesthesia and takes about two hours, shorter than a classic duodenal switch because there is one connection to build instead of two. For patients who already have a sleeve the operation is shorter still, since only the intestinal step remains.
Hospital stays nationally run one to three days. Dr. Karas sets discharge plans patient by patient within the same framework she applies to every operation, with overnight monitoring for insulin-dependent, anticoagulated, and cardiac patients as a fixed rule.
Preparation follows the same pathway as the sleeve and bypass: early consultation with Dr. Karas, full medical and nutritional workup, psychological evaluation, insurance documentation managed by the practice, and a two-week liquid diet before surgery. Recovery follows the same arc, with desk work in about two weeks and full activity by six.
Results
Head-to-head literature shows greater total weight loss and higher diabetes remission than either sleeve or bypass.
70 to 85 percent
Five-year data holds near 73 percent. In total body terms that is 35 to 38 percent, the highest figures of any bariatric operation.
Above 90 percent
Most patients come off diabetes medications entirely. The upper-intestinal reroute produces the deepest metabolic effect available.
50 pounds or more
For a patient starting at 400 pounds, the gap between a sleeve outcome and a SADI-S outcome can be 50 pounds or more.
The Tradeoffs
The same rerouting that makes SADI-S powerful makes it demanding. Because fat absorption drops, bowel habits change: stools are looser and more frequent, and heavy, greasy meals make that worse. Most patients describe this as manageable and a fair trade, and the ones who do best treat the dietary rules as permanent.
Nutrition is the serious commitment. SADI-S patients absorb less of the fat-soluble vitamins A, D, E, and K, along with iron and calcium. Bariatric-grade supplementation every day for life and lab work on a fixed schedule are the price of admission, and 8 to 12 percent of patients in published series developed a deficiency or significant diarrhea even so. Protein targets are the highest of any operation, around 90 grams daily.
Skipping vitamins after a SADI-S is not a small lapse, and Dr. Karas will not perform this operation for a patient who is not signed up for the follow-up it requires.
Surgical risks match other stapled operations: leak, bleeding, clots, and stricture, each in the low single digits, plus a roughly 2 percent rate of bile reflux specific to the loop configuration. Gallstones during rapid loss are common to every operation this effective.
Compare Your Options
Coverage for SADI-S has improved steadily since the 2020 endorsement, and it still varies more by plan than sleeve or bypass coverage does. A minority of plans still treat it as investigational. The practice verifies your specific benefits and, where a plan will not cover SADI-S, tells you before anything is scheduled and quotes one all-inclusive self-pay price. Financing is available through CareCredit and Cherry, so that number can be paid in easy monthly installments.
| SADI-S | Gastric sleeve | Gastric bypass | Mag-DI | |
|---|---|---|---|---|
| How it works | Sleeve plus one intestinal connection bypassing more than half the small intestine | About 80 percent of the stomach removed | Egg-sized pouch plus intestinal rerouting | Duodeno-ileal connection formed by magnets rather than staples |
| Typical weight loss | 70 to 85 percent of excess weight | 50 to 70 percent | 60 to 80 percent | Comparable to SADI-S |
| Connections built | One | None | Two | One, formed by compression |
| Dumping syndrome | Rare, the stomach valve is preserved | No | Possible with sugar | Rare |
| Vitamin commitment | The strictest of any operation | Standard bariatric vitamins | Higher, iron and B12 in particular | High |
| Availability here | Coming soon | Available now | Available now | Available now |
The closest comparison is Mag-DI, which creates a similar duodeno-ileal connection using magnetic compression instead of staples, and which Dr. Karas performs today.
Questions
Soon. The program is in its final preparation and consultations are open now. Patients evaluated ahead of launch are scheduled first. Call 216-377-7257 to get on the list.
It combines a full sleeve gastrectomy with an intestinal bypass of more than half the small intestine, so it restricts intake, lowers hunger hormones, and reduces calorie absorption all at once. Published excess weight loss runs 70 to 85 percent, the highest of any operation.
Often, yes. SADI-S builds on existing sleeve anatomy, adding only the intestinal step. For sleeve patients with regain it typically outperforms conversion to bypass on weight loss.
Rarely. The stomach’s outlet valve is preserved in SADI-S, so food leaves at a controlled pace. That valve is one of the operation’s main design advantages.
Two honest ones. Bowel habits change, with looser and more frequent stools, especially after fatty meals. And the vitamin and lab commitment is lifelong and not negotiable, stricter than sleeve or bypass. Patients unwilling to take that on should choose a different operation, and Dr. Karas will say so directly.
No. It has been performed since 2007, carries formal ASMBS endorsement since 2020, and is offered by major academic centers. Long-term data now extends past ten years.
About two hours laparoscopically. Stays nationally run one to three days, set per patient. Patients with insulin-dependent diabetes, blood thinners, or heart disease are monitored overnight as a fixed rule.
Increasingly yes, though more plans exclude it than exclude sleeve or bypass. The practice checks your exact benefits first and quotes transparent all-inclusive self-pay pricing where coverage falls short.
Both create a duodeno-ileal connection alongside a sleeve. SADI-S builds it with staplers in one operation. Mag-DI forms it with magnetic compression, with no staples or sutures at the connection. Dr. Karas offers both paths.
Schedule the consultation. The workup, insurance verification, and preparation months happen before any launch date matters, so starting now means no waiting later.
Financing Available
Financing is available for bariatric surgery, the Allurion balloon, Mag-DI and the medical weight loss program. Apply online in minutes, get a decision fast, and pay in monthly installments instead of all at once. Checking your options does not affect your credit score.
See financing options
Promotional financing on purchases of $200 or more, including no interest if paid in full within the promotional period, plus longer plans with fixed monthly payments on larger amounts. Prequalify online with no effect on your credit score. Accepted at Karas Weight Loss and Wellness.
CareCredit financing details →
Monthly payment plans up to 60 months, with 0% APR for qualifying applicants. Apply in about a minute with a soft credit check that does not affect your score. High approval rates, including for patients who have been turned down for a card before.
Cherry payment plan details →Financing is subject to credit approval. Get your written quote at a consultation and the office will help you set up a monthly payment plan. Read the full financing details.
Next Step
The workup, insurance verification, and preparation all happen before any launch date matters. Starting now means no waiting later.
Limited time
One visit with Dr. Karas covers the surgical options and the medical weight loss program with GLP-1 medication management, at the Lyndhurst or Westlake office, at no charge.
Or call 216.377.7257Free consultation
Free for new patients at both the Lyndhurst and Westlake offices.
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