Robotically Assisted Single Anastomosis Duodenoileal Bypass after Previous Sleeve Gastrectomy Implementing High Valuable Technology for Complex Procedures

Abstract

Staged bariatric procedures in high risk patients are a common used strategy for morbid obese patients nowadays. After previous sleeve gastrectomy, surgical treatments in order to complete weight loss or comorbidities improvements or resolutions are possible. One strategy is to perform a novel technique named SADI (single anastomosis duodenoileal bypass-sleeve). We present the technique for totally intracorporeal robotically assisted SADI using five ports and a liver retractor. We aim to see if the robotic technology offers more advantageous anastomosis and dissection obtained by the robotic approach in comparison to standard laparoscopy. The safety, feasibility, and reproducibility of a minimally invasive robotic surgical approach to complex abdominal operations such as SADI are discussed.

Figure 1

The SADI bypass includes a single duodenoileal anastomosis performed 300 cm from the ileocecal valve (a). Trocar placement according to the described technique (b).

Figure 2

Complete transection of the duodenum (a). Excision of the buttress material reinforcement material located on the gastric part (b). Duodenoileal anastomosis, posterior polypropylene layer (c). Posterior continuous resorbable suture (d).

Figure 3

Duodenoileal anastomosis: anterior layer first with a vicryl continuous layer (a) and finally with a polypropylene 3/0 anterior closure (b). Anastomosis leak test (c). Drain placement (d).