Case Record:
• Male, 57 years old
• Super-super-obesity (Weight 243.8 kg; BMI of 75.2 kg/m2)
Clinical History and Comorbidities:
• A 57-year-old male patient with a medical history of super-super obesity, type 2 diabetes, high blood pressure, heart failure (NYHA IV), hyperlipidemia, and sleep apnea syndrome, presented to our institution for management of his obesity and comorbid diseases.
After 1 month of multidisciplinary management a laparoscopic SADI-S was offered.
Procedure Steps:
1) Patient positioning, construction of the pneumoperitoneum with Veress needle, and port placement - 1 optical trocar (10mm), 3 working trocars (2= 12 mm, 1=5mm), and automatic liver retractor.
2) 50 Fr. (wide) Sleeve Gastrectomy (SG)
3) Oversewing of the SG staple line and pneumatic leak test
4) Identification of the ileocecal valve, measurement of 250-300 cm of the distal small bowel, and evaluation of the feasibility for the duodenal-ileal anastomosis (free of tension). Placement of distal and proximal marks
5) Dissection of the first portion of the duodenum toward the liver and transection 2-3 cm distal to the pylorus
6) Measurement of the biliopancreatic limb length, to estimate the total small bowel length
7) Creation of the 2-layer hand-sewn duodenal-ileal anastomosis
8) Oversewing staple line of the duodenal stump
9) Pneumatic leak test of the anastomosis
10) Placement of drain when desired, and removal of the remnant stomach
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