Patient Selection Considerations for OAGB and SADI-S

Case Record:

Single anastomosis duodenal switch: SADI SIPS

Clinical History:

34-year-old female with super morbid obesity, insulin resistance, gestational diabetes, with a BMI of 52.

Technique Description:

1. Measure bowel (300cm) from terminal ileum rotating to right upper quadrant and mark: Omental division not necessary
2. Dissect all posterior gastric adhesions so blood supply is only on lesser curvature elevating pylorus
3. On greater curve, dissect past pylorus (bipolar radiofrequency helpful)
4. Dissect the greater curvature to base of left crus
5. Divide duodenum on top of gastroduodenal artery and take superior tissue to allow it to centralize and eliminate tensión from anastomosis (use buttress)
6. Sleeve over 42 bougie starting 5 cm from pylorus and make straight
7. Suture anastomosis

Procedure Steps:

1. Measure bowel and mark
2. Dissect greater curvature down past pylorus and up to base of left crus of diaphragm
3. Take all posterior adhesions
4. Divide duodenum with buttress
5. Sleeve over 42 bougie straight and around 5 cm from pylorus
6. Handsewn anastomosis using barbed suture. Place OG tube on top of posterior layer into efferent limb to test and make anterior layer simpler

Learning Points:

• Measure appropriately and err on longer not shorter and why I use 300 cm
• Take all the adhesions and this makes encircling duodenum simple
• Buttress helpful when divide the duodenum
• Don’t make the sleeve too small
• Proper dissection allows for centralized anastomosis without tension