The Complete Guide to SADI-S in Turkey

This guide complements our SADI-S in Turkey procedure page and sits within our bariatric surgery in Turkey section. It explains what SADI-S is, who it suits, how it compares with a sleeve or a bypass, the full patient journey, eating and supplementation for life, the Canadian follow-up it requires, and how the price is built. This is the one procedure in our series where we do something we do nowhere else: we will not proceed with a SADI-S unless you have a confirmed follow-up arrangement in Canada before you travel. Section 12 explains exactly what that involves and how we help. At any point you can review our pricing in Turkey. Patients who have follow-up in place do exceptionally well with SADI-S; patients who do not are the reason we ask.

1. Understanding SADI-S

What the name means

Single Anastomosis Duodeno-Ileal bypass with Sleeve gastrectomy. It combines two elements: a sleeve gastrectomy, and a rerouting of the small intestine with a single surgical join.

What the operation does

Two steps, performed laparoscopically. A sleeve gastrectomy removes approximately three-quarters of the stomach, leaving a narrow tube. This is the restrictive component, and it also removes the main site producing the hunger hormone ghrelin. A duodeno-ileal bypass with a single anastomosis divides the duodenum just past the stomach and joins it directly to a loop of small intestine much further down, so food bypasses a substantial length of small intestine. The operation takes around two and a half to three hours.

Why it produces the strongest results

Three mechanisms work together, more powerfully than in any other procedure: restriction from the sleeve; substantial malabsorption, because a long segment of small intestine is bypassed — considerably more than in a Roux-en-Y bypass; and powerful hormonal change, from delivering food directly to the distal small intestine, which is what drives the diabetes effect.

How it compares to a classic duodenal switch

SADI-S is a modification of the older biliopancreatic diversion with duodenal switch. It uses one anastomosis rather than two, which makes it technically simpler, shorter to perform, and removes one potential site of leak or internal hernia. It retains most of the metabolic power of the classic operation with a somewhat less demanding profile — though it remains, by a clear margin, the most malabsorptive procedure in common bariatric practice.

What the results look like

The best in bariatric surgery. Weight loss exceeds that achieved with a sleeve or a Roux-en-Y bypass, and it is well maintained in published series. Diabetes remission rates are the highest of any procedure, including in patients with long-standing insulin-treated diabetes where other operations achieve improvement rather than remission. Your surgeon gives you a realistic expectation for your starting point.

Is it reversible?

The intestinal rerouting can be reversed surgically, and this is occasionally done where malabsorption proves difficult to manage. It is a major operation. The sleeve component is permanent. Treat SADI-S as a definitive decision, made with a clear understanding of what it asks of you.

2. Who SADI-S is for

This procedure has a narrower set of indications than a sleeve or a bypass, and identifying the right patient is the most important part of the assessment.

Where SADI-S is the strongest option

• A very high BMI. Where BMI is 50 or above, and particularly above 55, the additional power of SADI-S produces results that a sleeve or a bypass frequently does not.
• Severe, long-standing type 2 diabetes, especially insulin-treated diabetes of many years. This is where SADI-S most clearly outperforms other procedures — remission is achieved in patients where a bypass would achieve improvement.
• Revision after a sleeve with inadequate weight loss. Converting a sleeve to SADI-S is technically straightforward, since the sleeve is already in place, and it is one of the most effective revision options available.
• Where previous bariatric surgery has not delivered and a more powerful operation is warranted.

Where a sleeve or a bypass suits you better

• A BMI in the low forties without severe metabolic disease. A sleeve or a bypass will very likely achieve what you need, with substantially less demanding lifelong requirements. We would recommend one of those.
• Where lifelong supplementation and annual bloodwork are genuinely unlikely to happen. This is not a judgement — it is a practical assessment, and a sleeve is a considerably more forgiving operation in that situation.
• Where bloodwork access where you live is difficult or unreliable. Section 12 covers this, and for some patients it is the deciding factor.
• Existing significant malabsorption or inflammatory bowel disease, which requires specific assessment.
• Significant reflux, where a Roux-en-Y bypass frequently serves better.

How we approach the decision

Honestly, and with a clear statement of what each option would give you. A number of patients who enquire about SADI-S are better served by a sleeve or a bypass, and we say so — not because SADI-S does not work, but because it is a more demanding operation than they need for the result they want. Equally, for a patient with a BMI of 58 and fifteen years of insulin-treated diabetes, SADI-S is frequently the operation that will change their health most, and we say that too.

3. SADI-S compared with the alternatives

Reading the table honestly

SADI-S sits at one end of a spectrum. It delivers the most and it asks the most. The right question is not which procedure is best, but which one matches both your medical situation and your capacity to manage what it requires for the rest of your life. For a patient with a very high BMI and severe diabetes who will attend annual bloodwork, SADI-S is frequently the best answer available. For a patient with a BMI of 42 and no diabetes, a sleeve achieves what they need with a fraction of the long-term demands — that is the recommendation we would make.

Reflux

Worth noting: SADI-S includes a sleeve, so it carries the same reflux considerations as a sleeve. Where your endoscopy shows significant reflux, this is discussed specifically — and in some cases it points toward a Roux-en-Y bypass instead, accepting a somewhat less powerful metabolic effect in exchange for reflux resolution.

4. Why Canadians choose Turkey — and the Canadian route

The Canadian public route

Bariatric surgery is available in the public system in most provinces at no cost for patients who meet the criteria. Two things are worth knowing specifically about SADI-S. Waiting times are frequently two to five years. And SADI-S is offered at fewer Canadian centres than a sleeve or a bypass, since it is a more specialised procedure — so a patient who wants specifically this operation may face a longer route or a referral to a different centre.

We suggest asking your family doctor about a referral and what is available in your province. If the wait is manageable, the public route offers something we cannot: the whole team permanently in one place, including the dietitian and — critically for SADI-S — the follow-up. For this procedure in particular, that last point carries real weight. A public bariatric programme provides structured lifelong follow-up as part of the package. If that route is open to you within a reasonable time, it is genuinely the better option for a SADI-S.

If the wait is not liveable — and for a patient with a BMI of 55 and poorly controlled diabetes, several years is a serious health consideration — this is a reasonable alternative, chosen knowingly and with the follow-up arranged.

What our stay covers

Fourteen to twenty-one days, the longest in our bariatric series, and deliberately so. Section 13 explains why.

5. Assessment: a more thorough workup than for any other procedure

The online consultation

You send your details, and your surgeon reviews them. You receive an initial plan and quote — including, frequently, a recommendation that a sleeve or a bypass would serve you better. That happens often enough to mention.

What to send: your height, weight and BMI, all medical conditions and medications, your diabetes history including how long you have had it and whether you use insulin, your weight history, any previous abdominal or bariatric surgery, whether you have reflux, and a note of your access to bloodwork where you live. That last point is not administrative — it informs whether SADI-S is appropriate for you.

On-site assessment

• Upper gastrointestinal endoscopy — establishing reflux status, treating anything that needs treating, and providing the last straightforward look at the stomach being reduced.
• Comprehensive nutritional blood work — the most extensive baseline in our bariatric series: iron, ferritin, transferrin saturation, B12, folate, vitamin D, calcium, parathyroid hormone, magnesium, zinc, copper, selenium, vitamins A, E and K, albumin, prealbumin and full liver function. The fat-soluble vitamins and the protein markers matter here in a way they do not after a sleeve, because SADI-S affects both.
• Abdominal ultrasound, checking the liver and looking for gallstones.
• Cardiac and respiratory assessment, more thorough at a very high BMI.
• Sleep apnoea assessment, which at these BMI levels is frequently present and frequently undiagnosed.
• Anaesthetic review, reinforced for a longer operation at a higher BMI.
• Dietitian consultation — longer than for other procedures, covering your eating progression, your protein target, and your supplementation regime in detail.
• Internal medicine and diabetes review, since insulin and other medications will change substantially and quickly.

Why the protein markers matter

Because protein malnutrition is the specific nutritional risk of SADI-S, and it is the one that distinguishes it from a sleeve or a bypass. Knowing your baseline albumin and prealbumin makes your follow-up interpretable. A patient whose protein markers were already marginal needs a different plan and closer monitoring. This is not a theoretical concern, and it is entirely manageable with an adequate protein intake and monitoring — which is why both are built into your plan.

6. Preparing for surgery

The pre-operative diet

Two to four weeks, and for a very high BMI it may be longer. Its purpose is to reduce liver size, which makes laparoscopic access safer and easier — and at a high BMI this matters more, not less. Patients who follow it properly have shorter, more straightforward operations. Your dietitian provides the plan with Canadian-available foods.

Stopping smoking

Important before any abdominal surgery, and more so before a longer operation at a higher BMI where respiratory complications are a greater consideration. Stopping at least four weeks before makes a measurable difference. Canadian provincial quitlines are free, and combining behavioural with pharmacological support roughly doubles success rates.

Medications

Bring a complete list including supplements. Disclose specifically: insulin and all diabetes medications, which will change rapidly; blood thinners; hormonal contraception; anything for reflux; and any regular anti-inflammatory, since these are avoided permanently after SADI-S.

What to arrange at home before you travel

For SADI-S there are three things, and the first is a condition of proceeding.

• A confirmed follow-up arrangement with a Canadian doctor. Section 12 covers exactly what this means and how we help.
• Your supplements, purchased and ready. The list is longer than for any other bariatric procedure.
• Protein supplementation and soft food for the first weeks home.

7. Your trip, day by day

Fourteen to twenty-one days, depending on your BMI, your conditions and your recovery.

Day 1 — Arrival

Your driver meets you at the airport and takes you to your hotel with your companion. Nothing clinical today.

Days 2 to 3 — Assessment

The full workup across two days: endoscopy under sedation, comprehensive blood work, abdominal ultrasound, cardiac and respiratory assessment, sleep apnoea assessment, anaesthetic review, and internal medicine review of your diabetes. Then your surgeon consultation, and an extended dietitian appointment covering your eating progression, your protein target and your supplementation regime. By the end of this your plan is confirmed — including, where indicated, a recommendation for a different procedure.

Day 4 — Surgery

The operation under general anaesthesia, laparoscopically, around two and a half to three hours. You wake in your room, with monitoring appropriate to a longer operation at a higher BMI. You will be helped up to walk the same day — the single most effective measure against blood clots and chest complications, and it matters most in exactly this patient group. Nothing by mouth initially, then sips of water.

Days 5 to 8 — In hospital

Close monitoring, with observations, blood tests and daily clinical review. Progression from water to clear liquids. Mobilisation increases substantially — walking the corridor several times daily. Your diabetes medication is adjusted actively during this period, and frequently reduced considerably before you leave hospital. Four to five nights in hospital, longer where your surgeon prefers.

Day 9 — Transfer to hotel

Discharge to your hotel, with daily nursing visits from here. Progression to full liquids with an emphasis on protein from the outset.

Days 10 to 18 — Monitored recovery

Daily nursing visits, and your dietitian available throughout. This is the extended window that section 13 explains. Most patients feel substantially better each day. Short walks become comfortable, and a number manage a gentle outing by day twelve or thirteen. Your protein intake is monitored actively, which matters more after SADI-S than after any other procedure.

Days 19 to 21 — Final review and departure

Your surgeon reviews you. Repeat blood work before you travel, which is specific to this procedure. You receive your documentation: operative report describing the anatomy created including the common channel length, your endoscopy and pathology results, your baseline and pre-departure blood work, your written dietary progression with protein targets, your detailed supplementation prescription, and a follow-up schedule addressed to your Canadian doctor. The common channel length in your operative report is the single most important number any future doctor will want. Section 19 explains why. Then your transfer to the airport.

Why the range is fourteen to twenty-one

Because it depends on your BMI, your recovery and your blood work. Your surgeon confirms your date, and a number of patients stay toward the upper end — which we support rather than resist.

8. Recovery, week by week

Weeks 1 and 2 — in Turkey

Covered above. Hospital monitoring, then daily nursing. Liquids progressing with protein prioritised throughout.

Week 3 or 4

Home. Fatigue is the dominant feature and more pronounced than after a sleeve or a bypass — a longer operation, a higher starting BMI, and a very low intake. Pureed foods begin according to your plan, with protein first at every intake. Most patients return to desk work at four weeks after SADI-S.

Weeks 5 to 8

Energy improves. Soft foods progress. Weight loss is rapid and visible week to week — frequently more rapid than patients expect. Physical work: six weeks. No heavy lifting for six weeks.

Weeks 8 to 12

Solid foods reintroduced gradually. Portions remain very small. Bowel habit changes are expected after SADI-S and section 10 covers them. They are the most common adjustment patients report, and knowing about them in advance makes a substantial difference. Exercise progresses: walking throughout, light cardio from five weeks, resistance work from eight.

Months 3 to 6

The period of fastest loss. Diabetes medication changes are typically consolidated in this window, and a substantial proportion of patients are off insulin. Your first follow-up bloodwork is due at three months, and after SADI-S it is the most important appointment of your first year. Temporary hair thinning around months three to five is common and resolves.

Months 6 to 18

Loss continues and then stabilises. Protein intake and supplementation remain the focus. Bloodwork at six and twelve months.

Beyond 18 months

Weight stabilises. Follow-up continues annually for life, and after SADI-S this is genuinely not optional. Bloodwork, protein assessment, supplementation review.

9. Eating after SADI-S: protein is the priority

Why protein comes first, always

Because SADI-S bypasses a substantial length of small intestine, and protein absorption is reduced. Protein malnutrition is the specific nutritional risk of this operation. Your dietitian sets a daily protein target, and after SADI-S it is higher than after a sleeve or a bypass. Meeting it is the single most important dietary task you have, permanently. This is manageable and most patients meet it without difficulty once they have a routine. It requires deliberate attention rather than effort.

The stages

Clear liquids for the first days. Full liquids with protein supplementation through the first two weeks. Pureed roughly weeks three to five, protein first. Soft roughly weeks five to nine. Regular from around week ten, gradually.

The habits that matter permanently

• Protein first, at every meal and every snack. Your target is in your written plan.
• Protein supplementation as needed to reach the target — long term for some patients, and that is entirely normal after SADI-S rather than a sign of anything wrong.
• Small portions, eaten slowly.
• Do not drink with meals.
• Fluids between meals, to a daily target.
• Fat intake moderated, because fat absorption is reduced and excess fat produces the bowel effects in section 10.

What patients find harder than expected

Meeting the protein target, which takes deliberate planning rather than intuition. The fat restriction, which is more relevant after SADI-S than after other procedures. The bowel changes, covered next.

What patients find easier than expected

The weight loss, which is more rapid and more substantial than most anticipate. The diabetes change — for a patient who has injected insulin for a decade, stopping is a change patients describe in strong terms.

10. Bowel changes: what to expect

Worth its own section, because it is the adjustment patients most consistently report and the one they most appreciate being warned about.

What happens

SADI-S reduces fat absorption. Unabsorbed fat reaching the colon produces more frequent, looser and more odorous stools than before, and increased flatulence. This is expected physiology rather than a complication, and it affects most patients to some degree.

How much it affects daily life

It varies considerably. Some patients notice relatively little. Others find it a genuine adjustment in the first months. It improves over the first year as the intestine adapts, and it responds substantially to diet.

What manages it

• Moderating fat intake is the single most effective measure, and your dietitian covers it specifically. Patients who identify their own triggers — and they vary between individuals — manage it well.
• Avoiding very fatty meals, which produce the most noticeable effect.
• Timing, which patients work out for themselves within a few months.
• Where it remains troublesome, there are medications that help, and your follow-up doctor can prescribe them.

Being told beforehand

Patients who know to expect this handle it as an adjustment. Patients who do not are the ones who find the first months distressing and occasionally regret the operation. We would rather you knew. It is one of the genuine differences between SADI-S and a sleeve, and it is part of what you are weighing.

11. Supplementation: the most demanding of any bariatric procedure

Why

Because SADI-S bypasses a substantial length of intestine, which reduces absorption of iron, calcium, protein and — importantly — the fat-soluble vitamins A, D, E and K, which are absorbed with dietary fat. Fat-soluble vitamin deficiency is specific to malabsorptive procedures, and it is why the supplementation regime and the bloodwork panel are more extensive than after any other operation we perform.

What is typically required

• A complete bariatric multivitamin, formulated for malabsorptive surgery specifically — not a standard bariatric formulation and certainly not a supermarket multivitamin.
• Fat-soluble vitamins A, D, E and K, at doses set by your bloodwork. Frequently in water-miscible forms for better absorption.
• Vitamin B12, often by injection.
• Iron, at higher doses, taken separately from calcium.
• Calcium citrate with vitamin D, at higher doses than after a bypass.
• Protein supplementation, frequently long term.
• Zinc, copper, magnesium and selenium where your bloodwork indicates — and after SADI-S it more often does.

Your prescription is specific to your comprehensive baseline panel, which is why that panel is as extensive as it is.

Making it a routine

Patients who succeed set this up in the first month: a pill organiser, phone reminders, iron and calcium separated, and a protein routine built into the day. It becomes unremarkable within weeks. Patients who do not establish it are the ones who develop deficiencies — and after SADI-S those can be significant.

Where to buy them in Canada

Malabsorptive-formulation supplements and water-miscible fat-soluble vitamins are available in Canada from specialist suppliers and some pharmacies. Your plan names the formulations and doses so you can source equivalents. Buy your first three months before you travel. For SADI-S specifically, do not rely on sourcing them after you get home.

Bloodwork schedule

Three, six and twelve months, then annually for life — with a more extensive panel than any other bariatric procedure, including fat-soluble vitamins and protein markers. Your plan sets out the panel, addressed to your Canadian doctor.

12. Your Canadian follow-up: a condition of proceeding

This is the most important section on the page, and it is the one place in this entire series where we set a requirement rather than a recommendation.

The requirement

We will not proceed with a SADI-S unless you have a confirmed follow-up arrangement in Canada before you travel. Not a vague intention. A named doctor or clinic who has agreed to order your bloodwork on schedule and review your supplements.

Why we ask this of SADI-S and not of a sleeve

Because the consequences differ. A sleeve patient who neglects supplementation may develop a deficiency, and it is usually correctable. A SADI-S patient who neglects supplementation and protein intake can develop significant nutritional problems — protein malnutrition, fat-soluble vitamin deficiency — and these can be serious and are entirely preventable. The difference appears at year two, three or five, not at week six. By the time it appears, it is harder to correct than it would have been to prevent. We would rather ask an inconvenient question now than see that outcome.

What follow-up actually involves

Less than the requirement implies, and it is worth saying. Bloodwork at three, six and twelve months, then annually. A protein and supplementation review. And someone to ask if you have a question. That is the whole commitment. The panel is standard, the interpretation is straightforward with the schedule we provide, and the appointments are short.

Who can provide it

• Your family doctor, in most cases. The bloodwork is ordered on a standard requisition and the schedule tells them what to include.
• Some provinces have bariatric follow-up clinics that accept patients operated elsewhere, and where one is accessible to you it is an excellent option.
• A walk-in clinic can order bloodwork where a family doctor is not available, though continuity is better.

How to arrange it

Have the conversation before you travel: “I’m having a SADI-S — a malabsorptive bariatric operation. It requires lifelong bloodwork including fat-soluble vitamins and protein markers, at three, six and twelve months and then annually. I’ll come back with an operative report, my baseline bloodwork and a written schedule. Would you be able to order that bloodwork and review my supplements?” Most family doctors say yes. The schedule is provided, the panel is standard, and they are generally glad the plan exists.

If your doctor declines

Tell us, and we will work through the alternatives with you before you travel — bariatric follow-up clinics in your province, other options, and what is realistic where you live. If no arrangement can be made, we would recommend a sleeve instead. A sleeve is a considerably more forgiving operation, its results are good, and it is the right recommendation for a patient without reliable follow-up access. That is not us declining to help. It is us recommending the operation that will serve you best given your actual circumstances — and a number of patients have taken that advice and done very well.

A note for patients in remote communities

Bloodwork access varies substantially across Canada, and for some patients in northern and remote communities a comprehensive annual panel including fat-soluble vitamins is genuinely difficult to arrange. Tell us early, and we will work through it with you. Sometimes it is straightforward — bloodwork can be drawn locally and sent. Sometimes it is not, and in that case a sleeve is the better operation for you. We would rather have that conversation at the enquiry stage than after surgery.

13. The flight home: fourteen to twenty-one days

The interval

Fourteen days minimum, and frequently longer — up to twenty-one depending on your BMI, your recovery and your blood work. This is the longest stay in our bariatric series and the most important logistical element of your plan.

Why

Three reasons, and they compound. The operation is longer and more extensive, in a patient group with a higher BMI, which means the early recovery period is correspondingly longer. There is an anastomosis, and the window in which a leak would declare itself extends across the first two weeks. Nutritional and metabolic monitoring matters from the outset after a malabsorptive procedure, and repeat blood work before you travel is part of the plan. Staying through this period, with a bariatric team on hand, is what makes travelling for a SADI-S safe. A programme offering this operation on a ten-day stay is not planning for the recovery it requires.

Ask this of any programme

“How many days do I stay for a SADI-S, and why that number?” A specific answer referencing the anastomosis, the higher BMI group and the nutritional monitoring is what you want. Anything under fourteen days on this operation is a serious concern.

Making the flight comfortable

• Book an aisle seat. Walk every hour — thrombotic risk after a long abdominal operation in a higher-BMI patient warrants real attention, and continues after you land.
• Wear graduated compression stockings, and continue any prescribed anticoagulation exactly as directed. Anticoagulation is frequently continued for longer after SADI-S.
• Bring your fluids and sip constantly.
• Bring your own food and your protein supplement — small portions of something on your current stage.
• Do not book a same-day domestic connection. Build in an overnight stay near your Canadian arrival airport. For SADI-S we consider this essential rather than advisable.

14. Permanent practical points

Anti-inflammatory medication

Avoided permanently after SADI-S, as after a Roux-en-Y bypass. Ibuprofen, naproxen, diclofenac and similar drugs, prescribed or over the counter. Paracetamol is fine, and your doctor has alternatives. Tell any doctor or dentist treating you. If you take an anti-inflammatory regularly for a condition such as arthritis, raise it at your consultation — it may influence which operation suits you.

Oral contraception

Not reliably absorbed after SADI-S, more so than after a bypass. A non-oral method is needed — an intrauterine device, implant, injection or patch. This matters particularly in the first eighteen months, when pregnancy is best deferred and fertility frequently improves. Arrange it before you need it.

Alcohol

Absorbed faster and felt from considerably less than before, more markedly than after a sleeve. There is also a documented increase in problematic alcohol use after bariatric surgery in a proportion of patients. Worth being aware of, and worth mentioning to us if alcohol has been an issue for you.

Pregnancy

Possible, and many patients have healthy pregnancies. Fertility frequently improves. Wait eighteen to twenty-four months after SADI-S — longer than after a sleeve or a bypass, because nutritional stability takes longer to establish after a malabsorptive procedure. Your nutrition needs careful review before and during pregnancy, and your obstetrician must know you have had a malabsorptive bariatric operation. Fat-soluble vitamins, iron, B12 and protein all need active management.

15. The longer term

Weight loss and durability

The strongest and best-maintained of any bariatric procedure in published series. Some regain after two years is possible and usually modest. Protein intake, habits and follow-up determine how modest.

Diabetes

The highest remission rates of any procedure, frequently including patients with long-standing insulin-treated diabetes. Medication changes begin during your hospital stay and are typically consolidated by month six. Your Canadian doctor manages this, and the summary we send sets out where you were on discharge.

If malabsorption proves difficult

In a small proportion of patients, malabsorption is more troublesome than anticipated — persistent bowel symptoms, or nutritional markers that remain difficult to maintain despite good compliance. Where that happens, options exist: dietary adjustment, more intensive supplementation, and in a small number of cases surgical revision to lengthen the common channel, which reduces malabsorption. This is uncommon, it is manageable, and it is worth knowing the option exists rather than discovering it later.

Gallstones

Rapid weight loss increases the chance of gallstones becoming symptomatic. Your ultrasound checks for existing stones.

Internal hernia

Possible after any intestinal rerouting, though less so with a single anastomosis than with two. Presents as severe colicky abdominal pain, potentially years later. If you ever develop severe abdominal pain, seek medical attention and tell them you have had a SADI-S. Your operative report is what allows them to act appropriately.

Skin

Substantial weight loss — and after SADI-S it is frequently the most substantial — leaves loose skin, to a degree depending on how much you lose, your age and your skin quality. Body contouring is an option once your weight has been stable for at least six months, typically eighteen months or more after SADI-S. A number of our patients return for it, frequently in stages.

16. Aylan Clinic across Canada: 50 cities we serve

Aylan Clinic works with patients from every province and territory in Canada. Wherever you live, the process begins the same way: a free online consultation, with your details sent from home. Below are the fifty Canadian cities from which we most frequently receive enquiries. For SADI-S, we have also noted where follow-up access is the factor that shapes the recommendation — because on this procedure it is.

Greater Toronto Area and southern Ontario

Toronto is our single largest source of Canadian patients, and Pearson offers the most direct connections to Istanbul of any Canadian airport. For a procedure where the return journey matters, a direct flight is a genuine advantage. Across the wider Greater Toronto Area we regularly work with patients from Mississauga, Brampton, Markham, Vaughan, Richmond Hill and Oshawa. Along the lake: Hamilton, Burlington, Oakville, St. Catharines and Niagara Falls. In southwestern Ontario we see patients from London, from the Waterloo region — Kitchener, Waterloo and Cambridge — and from Guelph, Windsor and Barrie. Driving to Pearson rather than connecting domestically is strongly preferable. Follow-up access in these areas is generally straightforward, and several major centres have bariatric follow-up services.

Eastern and northern Ontario

Ottawa patients typically connect through Toronto or Montreal. Kingston patients generally drive to either. In northern Ontario we work with patients from Sudbury, Thunder Bay and Sault Ste. Marie. Journeys involve a domestic connection, so an overnight stay near your arrival airport is essential rather than advisable after this operation. For patients in these regions we discuss follow-up access specifically and early. Where a comprehensive annual panel is straightforward to arrange, SADI-S is entirely reasonable. Where it is not, we would recommend a sleeve — and we would rather establish that at the enquiry stage. Sudbury and Thunder Bay both have substantial francophone populations, served in French throughout including the dietitian consultation.

Montreal and the surrounding region

Montreal is our second-largest Canadian source, with excellent connections to Istanbul from Trudeau. Patients from Laval, Longueuil and Brossard are all within easy reach. Follow-up access is generally good, and Quebec has established bariatric services.

Quebec City and across the province

From Quebec City and the Capitale-Nationale region including Lévis, most patients connect through Montreal — as do patients from Trois-Rivières, Sherbrooke, Drummondville and Saint-Jérôme, all within driving distance of Trudeau, which is preferable to a domestic flight after this operation. Gatineau patients depart from Ottawa or drive to Montreal. From Saguenay, a domestic connection through Montreal is the norm, with an overnight buffer essential. All Quebec patients are served in French throughout — and on this procedure more than any other in our series. Your protein targets, your supplementation regime, your bloodwork panel and your operative report are documents you will rely on for the rest of your life, and they are provided in French. The extended dietitian consultation is conducted in French, and the follow-up schedule for your family physician is available in French. The permanent points in section 14, and the bowel changes in section 10, need to be understood precisely — and that is a conversation to have in your own language.

Vancouver and British Columbia

Vancouver patients connect through European hubs, typically one connection and a full day of travel. We schedule assessment across two days after arrival. Across the Lower Mainland: Surrey, Burnaby and Richmond. From Victoria and Nanaimo, patients cross by ferry or short flight — the ferry is considerably preferable on the return. Kelowna, Abbotsford and Kamloops patients connect through Vancouver or Calgary. Given the journey length, British Columbia patients frequently stay the full twenty-one days, and we generally recommend it.

Alberta

Calgary and Edmonton both offer good European connections, and Alberta is consistently among our strongest sources of bariatric patients. Red Deer and Lethbridge patients generally drive to Calgary. We schedule Alberta patients with the same two-day assessment approach as British Columbia.

Manitoba and Saskatchewan

Winnipeg patients connect through Toronto or Montreal. Saint-Boniface and Franco-Manitoban patients are served in French. From Saskatoon and Regina, journeys involve a domestic connection followed by a transatlantic flight. An overnight stay on the return is essential after this operation.

Atlantic Canada

Halifax patients typically route through Toronto or Montreal. In New Brunswick: Moncton, Fredericton and Saint John, with Moncton and surrounding Acadian communities served in French. Most connect through Montreal, which for francophone patients means French-language service throughout the journey. From Charlottetown and St. John’s, journeys involve one or two connections, with an overnight in between advisable.

Northern Canada

We work with patients from Whitehorse in Yukon, and from communities across the Northwest Territories and Nunavut. For northern patients, SADI-S requires a specific conversation, and we have it early. The journey itself is manageable — several of our patients from the territories have found it comparable in effort to travelling to a southern Canadian centre, with accommodation, meals, up to twenty-one days of monitored recovery and a companion all included. The question is follow-up. A comprehensive annual panel including fat-soluble vitamins and protein markers needs to be genuinely arrangeable where you live. Where bloodwork can be drawn locally and sent to a laboratory, that works. Where it cannot be reliably arranged, we would recommend a sleeve instead — and we would say so at the enquiry stage rather than after surgery. That recommendation is not a lesser option. A sleeve is a good operation with good results and far more forgiving requirements, and for a patient without reliable follow-up access it is the right choice.

How we handle the logistics

Whichever city you are travelling from, your coordinator arranges airport transfers at both ends in Istanbul, confirms your hotel before you depart, and builds your schedule around your arrival time. Five recommendations for SADI-S specifically. Allow two days for assessment. Book a changeable return fare, since your departure date depends on your recovery and your blood work. Do not book a same-day domestic connection — essential rather than advisable here. Arrange your Canadian follow-up before you travel, which is a condition of proceeding. And buy your supplements before you go.

17. What the package includes

• Free online consultation with a plan and quote, including whether a sleeve or bypass would serve you better.
• The most comprehensive workup in our bariatric series: upper GI endoscopy, extensive nutritional panel including fat-soluble vitamins and protein markers, abdominal ultrasound, cardiac and respiratory assessment, sleep apnoea assessment.
• Anaesthetic review reinforced for a longer operation at higher BMI.
• Internal medicine and diabetes review, with active medication management.
• Extended dietitian consultation with your written eating progression, protein targets and detailed supplementation regime.
• Surgeon consultation and your confirmed plan.
• The procedure, general anaesthesia, and hospitalisation.
• Four to five nights in hospital with close monitoring.
• Daily nursing visits for the remainder of your fourteen-to-twenty-one-day stay.
• Dietitian available throughout, with active protein monitoring.
• Medication, including extended anticoagulation as prescribed.
• Repeat blood work before departure.
• Your detailed supplementation prescription, specific to your comprehensive baseline.
• Written guidance on bowel changes, non-oral contraception and avoiding anti-inflammatories.
• Final surgical review before departure.
• Complete documentation: operative report including the common channel length, endoscopy and pathology results, baseline and pre-departure blood work, dietary progression with protein targets, detailed supplementation plan, and a follow-up schedule addressed to your Canadian doctor.
• Help establishing your Canadian follow-up arrangement before you travel — and we confirm it before proceeding.
• 5-star hotel accommodation, full board adapted to your dietary stage.
• A companion at no extra cost, accommodated and fed in the same room.
• Airport–clinic–hotel transfers.
• A personal coordinator from arrival to departure.
• English and French-speaking Canadian patient liaison available on request.

The clinical team

• Bariatric surgeon — SADI-S, duodenal switch and revision surgery.
• Gastroenterologist — pre-operative endoscopy.
• Anaesthetist — experienced in higher-BMI bariatric anaesthesia.
• Bariatric dietitian — protein targets, eating progression and supplementation.
• Internal medicine and diabetes specialist — active medication management.
• Dedicated nurse — daily post-operative care throughout your stay.

18. Results by patient profile

Long-standing insulin-treated diabetes

A patient in his fifties with a BMI of 54 and insulin-treated type 2 diabetes for fourteen years, on a provincial waiting list for over three years. His insulin was reduced substantially during his hospital stay and stopped at week seven. At two years his diabetes remains in remission and he has lost the majority of his excess weight. This is the presentation where SADI-S most clearly outperforms every alternative, and it is why the procedure exists.

Revision after a sleeve

A patient who had a sleeve six years earlier with inadequate loss and subsequent regain. Conversion to SADI-S, which is technically straightforward since the sleeve is already in place. One of the most effective revision options available, and a common reason patients enquire about SADI-S specifically.

A patient we recommended a sleeve for instead

A patient with a BMI of 43, no diabetes, who had read about SADI-S and wanted the most effective operation available. Her surgeon explained that a sleeve would very likely achieve what she wanted, with far less demanding lifelong requirements — and that SADI-S was a more demanding operation than her situation called for. She had the sleeve, lost what she hoped to, and has straightforward supplementation. Recommending the operation that fits rather than the most powerful one is what an assessment is for.

A patient where follow-up access decided it

A patient from a remote community with a BMI of 52 and type 2 diabetes, for whom SADI-S was medically well indicated. Comprehensive annual bloodwork including fat-soluble vitamins could not be reliably arranged where she lived. We recommended a sleeve, explaining exactly why. She had the sleeve, and her results have been good. Section 12 explains why we approach it this way.

A patient who established follow-up properly

A patient with a BMI of 56 whose family doctor agreed to the schedule before she travelled, and who has attended every appointment. Her vitamin A was low at six months, her dose was adjusted, and it corrected. Her albumin has remained normal throughout. That is the system working exactly as intended, and it is why the requirement exists.

Bowel changes managed well

A patient who found the bowel changes a real adjustment in the first three months and worked with the dietitian to identify her own fat triggers. By month eight it had settled substantially. She has said that being warned beforehand was what stopped her regretting the decision during those first months.

Body contouring in stages

A patient who lost an exceptional amount over twenty months and returned twice for contouring once her weight had been stable for eight months. Knowing the option existed from the outset helped her plan.

19. Your documentation: the common channel length

What you take home

Your operative report describing the anatomy created — including the length of the common channel, your endoscopy and pathology results, your baseline and pre-departure blood work, your dietary progression with protein targets, your detailed supplementation prescription, and your follow-up schedule.

Why the common channel length is the key number

The common channel is the segment of small intestine where food and digestive juices mix and absorption occurs. Its length determines how malabsorptive your operation is. Any doctor managing your nutrition — or considering a revision if malabsorption proves troublesome — needs that number. It determines what supplementation you require and what options exist if adjustment is needed. Without it, a Canadian doctor is managing your nutrition without knowing how malabsorptive your anatomy actually is. It is the single most important figure in your documentation.

What to do with it

Give a copy to your family doctor. Keep one yourself. Photograph it on your phone. Some patients carry a card noting: SADI-S, the date, the common channel length, that anti-inflammatories are contraindicated, and that severe abdominal pain warrants consideration of an internal hernia. It takes a minute and it is genuinely useful.

20. Practical points to know

What to expect

• Fatigue for the first four weeks, more pronounced than after a sleeve or bypass. Shoulder discomfort from the laparoscopic gas early on.
• Rapid and substantial weight loss, frequently more than patients expect.
• Bowel changes, covered in section 10 — the most common adjustment.
• Temporary hair thinning around months three to five, which resolves.
• A need for deliberate attention to protein, permanently.

Recognised points

SADI-S is a well-described procedure with strong published results in appropriately selected patients. Your surgeon will discuss the considerations relevant to you, and the extended stay with monitoring exists precisely to cover the early ones. The main ones: anastomotic leak, uncommon, with a window across the first two weeks — the reason for the extended stay. Bleeding, most likely in the first days. Venous thrombosis, which is why you walk within hours, wear stockings, and take extended anticoagulation as prescribed. Protein malnutrition, the specific nutritional risk of this operation, preventable with protein intake and detected by monitoring. Fat-soluble vitamin deficiency, specific to malabsorptive surgery, preventable with supplementation and detected by your bloodwork panel. Persistent bowel symptoms, expected to some degree, manageable by diet, and occasionally troublesome enough to warrant revision to lengthen the common channel. Internal hernia, uncommon, possible years later. Marginal ulcer, with smoking and anti-inflammatories as the main risks. Gallstones, more likely with rapid loss. Weight regain, usually modest. And loose skin, addressed later by body contouring if you wish.

Three things that determine your long-term outcome

• Meeting your protein target, permanently.
• Taking your supplements, including the fat-soluble vitamins.
• Attending your bloodwork, on schedule, for life.

All three are entirely achievable with a routine, and all three are why the follow-up arrangement is a condition of proceeding.

Who this suits

Adults with a very high BMI or severe metabolic disease, in a condition to undergo a longer abdominal operation, who understand the permanent requirements and who have reliable follow-up access.

Pregnancy

Not during pregnancy, and best deferred eighteen to twenty-four months afterwards with non-oral contraception in that window.

21. Price: how it is built and how to compare it

Why we quote per case rather than publishing a price list

Because the workup is the most extensive in our bariatric series, the stay ranges from fourteen to twenty-one days, and a revision SADI-S after a previous sleeve differs from a primary procedure. Your quote is built from your details, itemised, and fixed once you approve it. See our pricing in Turkey page for an overview of how our bariatric quotes are structured.

What determines your price

Five factors: whether it is a primary SADI-S or a revision after previous bariatric surgery; the extent of the workup, which at a very high BMI with metabolic disease is considerable; the length of your stay — fourteen to twenty-one days, with four to five nights in hospital and daily nursing afterwards; the complexity of your medical management, particularly insulin-treated diabetes requiring active adjustment; and whether a hiatus hernia repair is included, decided at endoscopy.

What is included in your quote

Everything in section 17, including the comprehensive workup, the extended dietitian consultation, four to five nights in hospital, daily nursing for the remainder of the stay, repeat blood work before departure, your detailed supplementation prescription, complete documentation with the common channel length, and our help establishing your Canadian follow-up arrangement. A companion is accommodated and fed at no additional cost.

What sits outside it

Flights, travel insurance, your supplements after the initial prescription, your follow-up bloodwork in Canada, and body contouring later if you choose it.

How to compare quotes properly

Six checks, and on SADI-S the differences between programmes are larger than on any other procedure.

• How many days is the stay, and how many nights in hospital? Fourteen to twenty-one days with four to five nights in hospital is the appropriate standard. Anything under fourteen days on this operation is a serious concern rather than a saving.
• Does the workup include fat-soluble vitamins and protein markers? A standard bariatric panel is not adequate for a malabsorptive procedure.
• Is the supplementation prescription based on your own comprehensive bloodwork, and does it include fat-soluble vitamins in appropriate forms?
• Does the operative report include the common channel length? It must. Section 19 explains why.
• Is repeat blood work done before you travel home?
• Does the programme engage with your Canadian follow-up? A programme offering SADI-S without asking how you will be followed is offering a malabsorptive operation without the element that makes it safe long term.

Why the lowest quote is a serious concern on this operation

We say this more directly here than anywhere else in our series. On SADI-S, the savings available concern the workup, the stay and the follow-up planning — and all three are what protect you from the specific nutritional risks of a malabsorptive procedure. A ten-day stay, a standard bariatric blood panel without fat-soluble vitamins, a generic supplement list, and no engagement with your Canadian follow-up: that combination is not a cheaper version of the same operation. It is a malabsorptive procedure without the framework that makes it work at year five. Ask any programme the six questions above and compare the answers.

Insurance in Canada

Bariatric surgery is available in the public system where you meet criteria, and care abroad is generally not reimbursed. Your follow-up in Canada is covered as ordinary medical care — bloodwork, physician visits, and prescribed supplements according to your provincial formulary. Some fat-soluble vitamin preparations may not be covered and are worth checking. Travel medical insurance is worth arranging, and read the exclusions carefully — many policies exclude complications of elective surgery, and bariatric surgery specifically in some cases. Ask in writing, and prioritise medical repatriation and hospitalisation cover.

Payment

A deposit confirms your dates. The balance is settled on site, under terms set out in full when you approve your plan. We confirm your Canadian follow-up arrangement before your dates are finalised. Where it cannot be established, we discuss a sleeve instead, and any deposit is applied to that plan or refunded.

Getting your figure

Send your height, weight and BMI, all medical conditions and medications, your diabetes history including duration and insulin use, your weight history, any previous abdominal or bariatric surgery, whether you have reflux, whether you use anti-inflammatories regularly, and a note on your access to bloodwork where you live. You will receive a plan and quote within 24 to 48 hours — including, where appropriate, a recommendation that a sleeve or a bypass would serve you better.

22. Glossary

• SADI-S — Single Anastomosis Duodeno-Ileal bypass with Sleeve gastrectomy.
• Common channel — the segment where food and digestive juices mix; its length determines malabsorption.
• Anastomosis — a surgical join; SADI-S creates one.
• Duodenum — the first part of the small intestine, divided in this operation.
• Malabsorptive — reduces absorption; SADI-S is the most malabsorptive procedure in common practice.
• Fat-soluble vitamins — A, D, E and K; absorbed with dietary fat, and specifically at risk.
• Protein malnutrition — the specific nutritional risk of SADI-S; preventable.
• Albumin and prealbumin — blood markers of protein status, monitored on your panel.
• Steatorrhoea — fatty, loose stools from reduced fat absorption.
• Duodenal switch — the older two-anastomosis operation SADI-S derives from.
• Revision to lengthen the common channel — a surgical option where malabsorption is troublesome.

23. How Canadians search for this

• “SADI-S surgery Turkey” — the most common search. Ask about the stay, the panel and the follow-up planning.
• “Most effective weight loss surgery” — SADI-S, for weight and for diabetes. And the most demanding.
• “SADI-S vs gastric bypass” — SADI-S is stronger for weight and diabetes, and considerably more malabsorptive. Section 3 compares them.
• “SADI-S vs duodenal switch” — SADI-S uses one anastomosis rather than two: simpler, shorter, with one fewer potential leak site.
• “Sleeve to SADI-S conversion” — technically straightforward and among the most effective revision options.
• “SADI-S diabetes remission” — the highest rates of any procedure, frequently including long-standing insulin-treated diabetes.
• “SADI-S vitamins for life” — the most demanding regime of any bariatric procedure, including fat-soluble vitamins A, D, E and K.
• “SADI-S protein malnutrition” — the specific nutritional risk, preventable with protein intake and monitoring.
• “SADI-S diarrhoea” — expected to some degree from reduced fat absorption. Improves over the first year and responds to diet.
• “SADI-S common channel length” — the key number in your operative report. Keep it.
• “How long to stay in Turkey for SADI-S” — fourteen to twenty-one days. Anything less is a concern on this operation.
• “SADI-S follow up requirements” — bloodwork at three, six and twelve months then annually for life, with an extended panel.
• “Is SADI-S available in Canada” — yes in the public system, at fewer centres than a sleeve or bypass. Ask your family doctor.

In summary

SADI-S at Aylan Clinic is the most effective bariatric operation available — the strongest weight loss and the highest diabetes remission rates of any procedure — delivered with the most comprehensive workup in our series, a fourteen-to-twenty-one-day stay with four to five nights in hospital, an extended dietitian programme with protein targets, and complete documentation including the common channel length. It is also the most demanding operation we perform, and we are direct about that because it is what makes it work.

Six things that matter: confirm SADI-S is the right operation for you — a very high BMI or severe long-standing diabetes points to it, while a BMI in the low forties without diabetes points to a sleeve, and we will say so; arrange your Canadian follow-up before you travel, a condition of proceeding rather than a recommendation, and if it cannot be arranged a sleeve is the right operation for you; stay fourteen to twenty-one days, since anything under fourteen on this operation is a serious concern; meet your protein target, permanently; take your supplements, including the fat-soluble vitamins, and attend your annual bloodwork for life; and keep your operative report and the common channel length, the number any doctor managing your nutrition will need. Ask your family doctor about the public route too — for SADI-S in particular, a public programme’s structured lifelong follow-up is a real advantage, and if the wait is workable, that is the better path.

When you are ready, review our SADI-S in Turkey procedure page for how the operation, the stay and the aftercare work, explore the wider bariatric surgery in Turkey section, and see our pricing in Turkey to understand how your personalised quote is built.