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Combined Re-sleeve and Single Anastomosis Sleeve Ileal (SASI) Bypass as a Second Stage After Sleeve Gastrectomy (Video Report)

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Abstract

Background

In comparison with purely restrictive procedures, combined restrictive and malabsorptive procedures seem to produce better weight loss and comorbidity control in patients with morbid obesity. Two-stage bariatric surgery is popular and is a safe and efficient strategy for patients with super obesity (BMI > 50 kg/m2) and super-super obesity (BMI > 60 kg/m2).

Methods

The patient in this video was a 36-year-old man with an initial BMI of 53.2 kg/m2. Two-stage bariatric surgery was planned. The patient underwent the first stage, laparoscopic sleeve gastrectomy, in 2018. Eighteen months after surgery, his lowest BMI was 38.8 kg/m2, and his excess weight loss was 50.9%. In 2021, he regained weight and reached a BMI of 42.4 kg/m2. Then, a second-stage bariatric surgery was performed.

Results

As shown in the video, combined re-sleeve and single anastomosis sleeve ileal (SASI) bypass constituted the second stage of bariatric surgery. During the operation, adhesiolysis was first performed, and the stomach was mobilized through a lateral-to-medial approach. Gastric transection was performed with a 36-Fr bougie. Then, the ileocecal junction was identified, and a location 250 cm from the cecum was selected as the anastomosis site. Gastro-ileal anastomosis (3 cm in diameter) was established with a stapler, and the two-layer suture method was used to close the defect. The postoperative period was uneventful, and the patient was discharged 5 days after surgery.

Conclusions

Combined re-sleeve and SASI bypass has a few surgical morbidities and is promising as an alternative to second-stage duodenal switch in patients with super obesity.

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Authors and Affiliations

  1. Department of General Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

    Fang-Chin Hsu & Hsin-Mei Pan

  2. Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan

    Fang-Chin Hsu, Hsin-Mei Pan, Ren-Tzer Wang & Kuo-Feng Hsu

Authors
  1. Fang-Chin Hsu
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  2. Hsin-Mei Pan
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  3. Ren-Tzer Wang
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  4. Kuo-Feng Hsu
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Corresponding author

Correspondence to Kuo-Feng Hsu.

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Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Key Points

• Single anastomosis sleeve ileal (SASI) bypass is a novel bariatric procedure, containing restrictive and malabsorptive effects.

• Two-stage bariatric surgery has fewer surgical risks and is preferred in patients with BMI > 50 kg/m2.

• We present a practical approach of combined re-sleeve and SASI bypass as a 2nd-stage post laparoscopic sleeve gastrectomy.

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Hsu, FC., Pan, HM., Wang, RT. et al. Combined Re-sleeve and Single Anastomosis Sleeve Ileal (SASI) Bypass as a Second Stage After Sleeve Gastrectomy (Video Report). OBES SURG 31, 5514–5516 (2021). https://doi.org/10.1007/s11695-021-05737-8

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  • DOI: https://doi.org/10.1007/s11695-021-05737-8

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