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BPD-DS and SADI-S · Safety guide
Both versions of the duodenal switch, traditional BPD-DS and the newer SADI-S, carry the usual risks of surgery plus long-term nutrition risks, because they reduce how much your body absorbs. This guide explains each risk, how the two versions differ and the warning signs to watch for.
Renew performs SADI-S with Dr. Pérez in Tijuana and Cancún.
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The numbers
Most research on the duodenal switch comes from experienced centers, and long-term SADI-S data are still limited. These figures come from the largest recent reviews and comparisons.
In the first weeks
Fluid can leak from the staple line or a new connection. SADI-S has one connection to heal and BPD-DS has two.
Bleeding can happen along the staple line or at the incisions.
Clots can form in the legs or lungs. Walking soon after surgery helps lower the risk.
As with any surgery, wounds can become infected, and anesthesia carries its own risks.
Months and years later
The long-term risks of a duodenal switch mostly come from absorbing less food, vitamins and minerals. The longer the shared section of intestine where food meets digestive juices (the common channel), the more you absorb.
| Risk | What happens | BPD-DS vs SADI-S |
|---|---|---|
| Vitamin and mineral deficiencies | Your body absorbs less of some vitamins and minerals, including the fat-soluble vitamins A, D, E and K. | In a 5-year study, BPD-DS patients had lower vitamin B12, iron, vitamin E and zinc levels than SADI-S patients. |
| Protein malnutrition | Too little protein is absorbed, which can lower albumin levels in your blood. | SADI-S was changed from a 200 cm common channel to 250 cm and then 300 cm or more because of low albumin. Reoperations for malnutrition were linked to 200 cm. |
| Loose stools and gas | Bowel movements can be looser and more frequent, and you may pass more gas. | Seen after both. Some SADI-S patients had chronic diarrhea (4 or more loose stools a day for 4 weeks or more) even with a 300 cm channel. |
| Reflux | Acid or bile can back up into the esophagus. SADI-S can worsen reflux or cause new reflux. | In the 5-year study, 2 SADI-S patients needed surgery for bile reflux. |
| Internal hernia | A loop of intestine can slip through a gap created by the rerouting and get trapped. It needs prompt care. | In the same study, 1 patient in each group needed surgery for an internal hernia. |
From the multicenter DS vs SADI-S study, 5-year results, the ASMBS updated statement on SADI-S, 2020, Sanchez-Cordero et al., Obesity Surgery, 2025, ASMBS and Cleveland Clinic.
Is gallbladder removal part of a duodenal switch? No. The ASMBS and Cleveland Clinic descriptions of SADI-S do not include removing the gallbladder. If you have gallstones, your surgeon will discuss it with you before surgery.
When to get help
Contact your care team right away if you have any of these after SADI-S (Cleveland Clinic). For a medical emergency, call 911 or go to the nearest emergency room.
Pain that is severe or getting worse.
Frequent watery stools that don’t ease.
Peeing less, a dry mouth or a headache.
A fever, or vomiting that doesn’t stop.
Protect your results
Send your health history and Dr. Pérez’s team will review it. Virtual consultations are available.
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“So thankful for the wonderful staff and coordinators on site, the pre-op coordinator and nutritionist, my amazing nurses and the wonderful Dr. Perez. They made everything so easy and cared for me diligently and with kindness.”
“Wonderful experience in every way. The support and services were exceptional from the beginning of planning my surgery to the follow up care and support system. Dr Perez and all of the staff from nurses to drivers to the coordinators were exactly what was needed and more.”
“I had an amazing experience with Renew Bariatrics throughout the entire process, from consultation with one of their patient coordinators to now being in the post-op phase. They are extremely communicative, always checking in and providing you with information needed for each step of the process. Dr. Perez is the best!”
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Every surgery has risks. In a review of four five-year SADI-S studies, short-term complications ranged from 5.4% to 11.6%, long-term complications from 8.7% to 17.9%, and death rates were consistently low. The biggest long-term risks are vitamin, mineral and protein deficiencies.
Studies are mixed. In a multicenter study, short-term complications were similar (11.6% after SADI-S vs 11.8% after BPD-DS). Another comparison found more complications and longer hospital stays after BPD-DS. SADI-S patients also had better vitamin and mineral levels.
Looser, more frequent bowel movements and gas are common after both versions. Chronic diarrhea is less common. Tell your care team if it doesn’t ease, because diet changes or medication can help.
You will take supplements for life, including higher doses of vitamin A, vitamin K, calcium, zinc and copper than after other weight loss surgeries. Our nutritionists set your plan, and regular labs check your levels.
No. Removing the gallbladder is not a standard part of SADI-S. If you have gallstones, your surgeon will discuss it with you.
Contact your care team right away for severe abdominal pain, severe diarrhea, signs of dehydration, a fever, or vomiting that doesn’t stop.
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No commitment. A coordinator will contact you.
