Robotic single anastomosis duodeno-ileal bypass as a second step after a sleeve gastrectomy

Obesity is considered to be one of the 21st century epidemics. Bariatric surgery has shown excellent results for weight loss and comorbidity resolution in the long-term. In the case of super obese patients, one of the options is to perform a two-step procedure. First, a restrictive procedure such as a sleeve gastrectomy (SG) will allow the patient to lose weight and improve their comorbidities, thus facilitating the surgical technique and perioperative management in the performance of the second and definitive procedure, usually a malabsorptive technique. 

In this case, a conversion from SG to single anastomosis duodeno-ileal bypass (SADI-S) was performed on a 49-year-old male with a BMI of 38 Kg/m2. He had undergone a SG 7 years earlier, with an initial weight loss of nearly 50 Kg, and a subsequent weight regain of 25 Kg. He had also undergone a laparoscopic cholecystectomy 3 years before the second-step procedure. He showed no symptoms of GERD.

A robotically assisted SADI-S was performed. The surgery was uneventful and took 135 minutes. A hand-sewn two-layer duodeno-ileal anastomosis was made 275 cm previous to the ileocecal valve. The postoperative course was also uneventful, and the patient was discharged on the second day after surgery.