What makes the SADI-S procedure highly effective is that it not only makes the stomach smaller, restricting food intake, but also creates an intestinal bypass, shortening the route digested food travels and limiting the calories absorbed.

Dr. Cheema prefers to operate robotically because the device affords greater visualization and technical control. Through four small incisions in the abdomen, he combines two procedures that total two and a half hours. In the first, called a sleeve gastrectomy, he removes about 80 percent of the stomach, leaving behind a banana-shaped pouch. For the second procedure, called an intestinal bypass, he divides the uppermost portion of the small intestine, or duodenum, just below the stomach.

Dr. Cheema reattaches one end of the intestine, measuring about half the length of the small intestine, to the end of the stomach pouch, a connection called an anastomosis. Unlike other bariatric procedures, the SADI-S creates a new route that allows food to bypass more than half of the small intestine. Food is redirected through the pouch and directly into the lower portion of the small intestine, or ileum. By reconfiguring the intestinal tract, the SADI-S essentially rewires how the gut signals the brain, triggering hormonal changes that curb hunger and cravings. “After surgery, patients must adhere to a high-protein diet and multivitamins to prevent malnutrition,” Dr. Cheema explains, “but aside from that, there’s not much of a dietary downside.”