Sleeve Plus Bypass

In 2026, Sleeve Plus Bypass (often clinically termed SADI-S or SASI) represents the "next generation" of bariatric surgery. It is a hybrid (mixed) procedure that combines the restrictive benefits of a sleeve gastrectomy with the powerful metabolic and malabsorptive benefits of an intestinal bypass.

Unlike the traditional Roux-en-Y bypass, these modern "Sleeve Plus" variants typically preserve the pylorus (the valve at the bottom of the stomach), which significantly reduces the risk of "dumping syndrome" and improves blood sugar stability.

1. What is it? Any common name for this procedure?

These procedures involve first performing a Sleeve Gastrectomy (removing ~75% of the stomach) and then adding an Intestinal Bypass to reroute food away from a portion of the small intestine.

Common Names & Variants:

• SADI-S: Single Anastomosis Duodeno-Ileal bypass with Sleeve gastrectomy.
• SIPS: Stomach Intestinal Pylorus-Sparing surgery.
• SASI: Single Anastomosis Stomach-Ileal Bypass (often marketed simply as "Sleeve Plus").
• Loop Duodenal Switch: A simplified version of the traditional Duodenal Switch.

2. Common Indications: When is it Recommended?

This procedure is typically reserved for patients who require a more "powerful" metabolic intervention than a standard sleeve or bypass can provide:

• High BMI: Specifically for patients with a $BMI > 45$ or $50$ (Class III obesity).
• Severe Metabolic Disease: Especially long-standing or poorly controlled Type 2 Diabetes.
• Weight Regain: Often used as a Revision Surgery for patients who had a previous Gastric Sleeve but did not reach their goals or experienced weight regain.

3. List of Associated Diseases and Conditions

"Sleeve Plus" techniques are highly effective for treating "Metabolic Syndrome":

• Type 2 Diabetes Mellitus: Offers the highest remission rates among all bariatric procedures (up to 95%).
• MASLD (Fatty Liver Disease): Significant reduction in liver fat and inflammation.
• Severe Sleep Apnea: Rapid weight loss often leads to the discontinuation of CPAP therapy.
• Hyperlipidemia: Superior at lowering "bad" cholesterol and triglycerides compared to standard bypass.

4. List of Screening Tests and Assessment Tools

Before approval, patients undergo a rigorous "Metabolic Mapping":

• Upper Endoscopy (EGD): To ensure there is no severe acid reflux (GERD) or hiatal hernia, which might affect the choice between SADI-S and SASI.
• Nutritional Panel: Baseline testing for Fat-Soluble Vitamins (A, D, E, K), Iron, Zinc, and Protein.
• Cardiac/Sleep Clearance: EKG and Sleep Study to manage anesthesia risks.
• Psychosocial Evaluation: To confirm readiness for the complex lifelong vitamin and protein requirements.

5. Am I Eligible for This Evaluation?

Eligibility in 2026 follows the updated ASMBS/IFSO guidelines:

1. BMI Criteria: $BMI \geq 35$ regardless of comorbidities, or $BMI \geq 30$ with uncontrolled metabolic disease like Type 2 Diabetes.
2. Commitment to Supplementation: Because these procedures cause higher malabsorption, you must agree to a lifelong, high-intensity vitamin regimen.
3. Non-Smoker: Must be nicotine-free for at least 6–8 weeks prior to surgery to prevent ulcers at the intestinal connection.

6. Pre and Post Care

Post-Care (The Maintenance):

• Liver Shrinkage Diet: 2–3 weeks of a very low-calorie liquid diet to reduce abdominal fat and liver size for safer surgical access.
• Protein "Loading": Increasing daily protein intake early to prepare the body for the malabsorptive phase.

Post-Care (The Maintenance):

• The "Plus" Vitamins: Lifelong daily intake of specialized bariatric multivitamins plus additional Vitamins A, D, E, and K.
• High Protein Requirement: Aiming for 80 to 120 grams of protein daily—about 30% more than a standard sleeve—to prevent muscle wasting.
• Hydration: Minimum of 64 ounces of fluid, sipped slowly to avoid stomach pressure.

7. Days Required for Hospitalization

• Surgical Time: 2 to 3 hours (often robotic-assisted).
• In-Hospital Stay: 1 to 3 Days. Most patients are discharged once they can tolerate clear liquids and their pain is controlled.
• Recovery: Return to light work in 2 to 3 weeks and full exercise in 6 weeks.
• Hospitalization: 1–3 Days.

8. Benefits of Sleeve Plus Bypass

• Superior Weight Loss: Patients typically lose 80% to 100% of their excess body weight within 18–24 months.
• Pylorus Sparing: Keeping the stomach valve intact prevents the "sugar crashes" and sudden diarrhea associated with standard bypass.
• Metabolic Dominance: It is currently considered the most effective surgery for putting Type 2 Diabetes into long-term remission.
• Lower Complication Risk: SADI-S/SIPS has a lower risk of internal hernias compared to the traditional Roux-en-Y because there is only one intestinal connection.