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

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.