By Dr. Sandy Martinez, Bariatric Surgeon
If you are researching weight loss surgery options, you have likely come across a variety of acronyms that can be confusing. Lately, many patients traveling to our practice in Tijuana have been asking about the SASI procedure, often confusing it with the widely accepted SADI-S surgery.
While they sound similar, the difference between them is massive. At our clinic, patient safety and long-term health are our top priorities. Before you book a surgery date, here is the hard clinical truth about why you should avoid the SASI procedure.
The Single Anastomosis Stomach-Ileal (SASI) bypass is one of many forms of bariatric surgery. However, as of 2026, both the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity (IFSO)—the two major bodies of bariatric authorities (see my ASMBS and IFSO fellowships)—have not approved SASI as a standard primary procedure.
It remains strictly in the experimental phase. Unlike theSADI-S procedure—which has years of clinical backing and proven safety—undergoing a SASI surgery is essentially letting your body become a testing ground.
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When we look at the meta-analyses published in top bariatric journals, the numbers are highly concerning. Surgeon and researcher Dr. Joselio Rodrigues and colleagues reported that the SASI procedure carries an overall complication rate as high as 13.7% (where severe complications accounted for almost half - 5.18%).
By connecting the gastric antrum directly to the ileum, the SASI procedure destroys your natural anti-reflux barrier. This anatomical flaw opens the floodgates for severe bile (alkaline) reflux. The data is clear:
1. Massive Reflux Increase: Endoscopic studies prove that bile reflux jumps from 11.4% pre-op to over 62% after a SASI surgery—as reported by Dr. Joanna Parkitna and colleagues.
2. Excess Weight Loss and Malnutrition: After a 1-year follow-up after SASI, Dr.Mohammad Kermansaravi and his colleagues reported concern due to a marked trend in Excess Weight Loss (see Beyond Ideal: Excessive Weight Loss After Bariatric Surgery), as well as a marked protein malnutrition, recommended ultimately to not be performed as a primary procedure.
3. High Reversal-Revision Rate: In an instance where 3 patients were offered SASI as a primary procedure, all three of them had to undergo a revision surgery where they reversed the procedure to a gastric sleeve due to the excessive weight loss and malnutrition—as reported by Dr.Wang and colleagues.
If the complication rates are so high, why is it still being offered? The unfortunate reality is that the SASI approach saves the surgeon about 15 to 20 minutes in the operating room because it is technically easier to perform.
However, a procedure that is faster for the surgeon but offers zero physiological or safety benefits to your body is not a medical advancement, it is a shortcut which high risk potential.
When deciding to cross the border for life-changing bariatric surgery, you deserve a medical team that relies on hard clinical data, not experimental shortcuts. If you have been offered the SASI procedure, I highly encourage you to get a second opinion.
In my main webpage, you will find a section of Procedures: We encourage you to look through them and to discuss the best option in our video-consultation and with my multidisciplinary team.
Contact our team today to schedule a consultation. We will help you find the right, fully approved procedure for your unique body and health goals.
