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Revisional Single Anastomosis Sleeve Ileal (SASI) Bypass for Failed Gastric Clipping and Proximal Jejunal Bypass (GC-PJB) (Video Report)

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Abstract

Background

Bariatric surgery, the most effective strategy to manage morbid obesity, has increased rapidly in the face of expanding obese population in the twenty-first century. Hence, it is reasonable to expect a rise in the need for revisional bariatric surgery (RBS), especially due to weight recidivism.

Method

In this video report, the patient was a 28-year-old Asian female with an initial BMI of 42.6 kg/m2 and underwent primary bariatric surgery of laparoscopic gastric clipping with proximal jejunal bypass (GC-PJB) in January 2018. She had the nadir BMI of 35.2 kg/m2 in August 2019. However, she regained weight and her BMI rebounded to 43.7 kg/m2 at the time of consultation for RBS in 2021. After a multidisciplinary team evaluation, laparoscopic procedures of removal of gastric clip and single anastomosis sleeve ileal (SASI) bypass with preservation of previous jejunojejunal anastomosis were performed.

Results

The operative time was 216 min and blood loss was 25 ml. There were no intraoperative or postoperative complications. The patient had an uneventful postoperative course and was discharged 4 days after surgery. At the 3-month follow-up after RBS, the patient had lost 25 kg (weight dropped from 119 to 94 kg), and the corresponding BMI was 34.5 kg/m2.

Conclusion

Laparoscopic removal of gastric clip and SASI bypass with preservation of previous jejunojejunal anastomosis is technically feasible and promising as a revisional procedure for failed GC-PJB.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan

    Hsin-Mei Pan, Chien-Hua Lin, Fang-Chin Hsu, Wan-Ting Hung, Guo-Shiou Liao, De-Chuan Chan, Teng-Wei Chen & Kuo-Feng Hsu

  2. Department of General Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

    Hsin-Mei Pan

  3. IRCAD Taiwan, Department of Surgery, Chang-Bing Show Chwan Memorial Hospital, Taipei, Taiwan

    Chien-Hua Lin

  4. Division of General Surgery, Department of Surgery, Taichung Armed Forces General Hospital, Taichung, Taiwan

    Wan-Ting Hung

Authors
  1. Hsin-Mei Pan
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  2. Chien-Hua Lin
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  5. Guo-Shiou Liao
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  7. Teng-Wei Chen
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  8. Kuo-Feng Hsu
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Corresponding author

Correspondence to Kuo-Feng Hsu.

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Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Key Points

1. As primary bariatric surgery is widely performed, a rise in the need for revisional surgery has been observed.

2. Regarding the choice of revisional bariatric procedures, the following factors should be taken into consideration, including the causes of revision, the severity of obesity, metabolic issues, the patient’s expectation, and the surgeon’s experience.

3. We present a practical revisional procedure of removal of gastric clip and single anastomosis sleeve ileal bypass with preservation of previous jejunojejunal anastomosis for failed gastric clipping and proximal jejunal bypass.

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Pan, HM., Lin, CH., Hsu, FC. et al. Revisional Single Anastomosis Sleeve Ileal (SASI) Bypass for Failed Gastric Clipping and Proximal Jejunal Bypass (GC-PJB) (Video Report). OBES SURG 31, 5510–5513 (2021). https://doi.org/10.1007/s11695-021-05733-y

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