Z Gastroenterol 2017; 55(08): e57-e299
DOI: 10.1055/s-0037-1605173
Kurzvorträge
Metabolische/Endokrine Chirurgie
Metabolische Chirurgie: Experimentell, klinisch und wirtschaftlich: Donnerstag, 14 September 2017, 13:55 – 15:15, Coventry/Forschungsforum 4
Georg Thieme Verlag KG Stuttgart · New York

SADI-S – Single Anastomosis Duodeno-Ileal Bypass with sleeve gastrectomy as a growing indication as a single-step procedure for super-superobese patients- technical aspects (VIDEO)

J Schulte-Mäter
1   Charité – Universitätsmedizin Berlin, Zentrum für Innovative Chirurgie, Zentrum für Adipositas und Metabolische Chirurgie, Chirurgische Klinik, Campus Virchow-Klinikum (CVK), Campus Charité Mitte (CCM), Berlin, Deutschland
,
C Bures
1   Charité – Universitätsmedizin Berlin, Zentrum für Innovative Chirurgie, Zentrum für Adipositas und Metabolische Chirurgie, Chirurgische Klinik, Campus Virchow-Klinikum (CVK), Campus Charité Mitte (CCM), Berlin, Deutschland
,
A Brandl
1   Charité – Universitätsmedizin Berlin, Zentrum für Innovative Chirurgie, Zentrum für Adipositas und Metabolische Chirurgie, Chirurgische Klinik, Campus Virchow-Klinikum (CVK), Campus Charité Mitte (CCM), Berlin, Deutschland
,
C Denecke
1   Charité – Universitätsmedizin Berlin, Zentrum für Innovative Chirurgie, Zentrum für Adipositas und Metabolische Chirurgie, Chirurgische Klinik, Campus Virchow-Klinikum (CVK), Campus Charité Mitte (CCM), Berlin, Deutschland
,
J Pratschke
2   Charité – Universitätsmedizin Berlin, Chirurgische Klinik, Campus Virchow-Klinikum (CVK), Campus Charité Mitte (CCM), Berlin, Deutschland
,
R Zorron
1   Charité – Universitätsmedizin Berlin, Zentrum für Innovative Chirurgie, Zentrum für Adipositas und Metabolische Chirurgie, Chirurgische Klinik, Campus Virchow-Klinikum (CVK), Campus Charité Mitte (CCM), Berlin, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
02 August 2017 (online)

Also available at
 

Objectives:

Super-Superobese patients (BMI higher then 60 kg/m2) are of difficult primary bariatric management. Issues regarding exposure and technical difficult anastomosis led to the choice of a 2-stage procedure, usually a sleeve gastrectomy as the first step. In the majority of cases, patients have an unsatisfactory EWL (excess weight loss) after 2 years and high rates still remain in obesity class III.

Methods:

Patients with BMI over 60 kg/m2 without esophageal reflux symptomatic were scheduled for a single-step SADI-S procedure. The video describes the technical steps of the procedure, and identified key issues to perform this technique safely. 1. Position: Patient supine, the surgeon stands at the right side to perform sleeve resection, switches to the left side to perform the anastomosis. 2. Six trocars were inserted. 3. The omentum is separated from the greater curvature close to the stomach using harmonic reaching the left crus and sleeve gastrectomy is performed over a 42-Fr Bougie. 4. First segment of the duodenum is stapled. 5. The small bowel loop for the anastomosis is identified going backwards 300 cm from the ileocecal junction. 6. Anastomosis is performed in a 2 row fashion or using linear stapler. A drain is placed for the duodenal stump.

Results:

SADI-S was performed in this selected group of patients and the technical issues were identified. The anastomosis can be performed using the linear stapler when possible, or a two-layer hand sewing suture. Covering the sleeve staple line with a synthetic, bioabsorbable staple line reinforcement tissue is advised to avoid staple line complications.

Conclusions:

This new technique is a promising option in our surgical armamentarium to provide effective therapy for obesity patients classified as super-superobese. In the literature, performing SADI-S as a single procedure showed better EWL than patients submitted to 2 stage procedures.