Laparoscopic Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy: Surgical Technique
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MULTIMEDIA ARTICLE
Laparoscopic Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy: Surgical Technique Amit Surve 1 & Ravi Rao 2
&
Daniel Cottam 1
Received: 9 June 2020 / Revised: 1 July 2020 / Accepted: 6 July 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract This video shows a case of a 57-year-old female patient with morbid obesity who underwent a laparoscopic single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). Keywords SADI-S . Laparoscopic . Surgical technique . Australia . Loop duodenal switch . Bariatric
The major steps involved when performing a laparoscopic SADI-S procedure include walking of the small bowel, tacking of the small bowel, dissection of the greater curvature of the stomach, duodenal dissection, sleeve creation, duodenal transection, creation of the DI, and the leak test [video]. The single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) procedure is a modification of the traditional duodenal switch procedure [1, 2]. The procedure has shown to be effective in patients with morbid obesity [3]. There have been only a few reports on the surgical technique of laparoscopic primary SADI-S procedure and its associated complications [4–9].
Purpose In this video report, we have presented a step-by-step surgical technique of laparoscopic primary SADI-S procedure [video].
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04847-z) contains supplementary material, which is available to authorized users. * Ravi Rao [email protected] 1
Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT 84102, USA
2
Perth Surgical & Bariatrics, 30 Churchill Avenue, Subiaco, WA 6008, Australia
Materials and Methods This is a case of a 57-year-old female patient with a body mass index (BMI) of 49.5 kg/m2 with obesity-related comorbidities like type 2 diabetes (T2D), hypertension (HTN), and obstructive sleep apnea (OSA). We decided to perform a laparoscopic SADI-S procedure.
Surgical Technique Our surgical technique has been described previously [1]. Laparoscopic SADI-S surgery was performed with a standard five-port technique. Initial access was through a 5-mm Applied Medical Kii Fios first entry port at Palmer’s point using a 0° scope. Palmer’s point is at a range of 3 cm below the left subcostal in the midclavicular line [video]. Pneumoperitoneum was established to a pressure of 15mmHg with CO2 gas. A 5-mm 45° laparoscopic camera was used. Next, a 15-mm port was introduced through the umbilicus. Two 5-mm ports were then introduced two finger breadths beneath the right and left subcostal margins. The last 5-mm port was placed in the right lumbar quadrant in the mid-clavicular line at a variable point based on the patient’s body habitus. A Snowden Pencer Liver retraction system was used with the retractor introduced through the right subcostal port. The surgeon (standing on the right side of the patient) operated through the right midclavicular line lumbar
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