Technical Steps to perform a SADI-S Procedure

Case Record:

• Female, 45 y.o.

• 115 kg

• 153 cm

• 49 kg/m2

Clinical History:

• Lap chole

• Obstructive apnoea

• No gerd, no hiatal hernia

Technique Description:

1. Sleeve gastrectomy over a 54 french bougie. Duodenal section and anastomosis to the ileum 250 cm from the ileo-cecal junction.

Procedures Steps:

1. Division of short gastric vessels and branches of the right gastroepiploic artery

2. Dissection of the duodenum down to the bile duct

3. Gastric sleeve resection over a wide bougie

4. Division of the duodenum

5. Measurement of the small bowel from the ileocecal junction upwards

6. Duodeno-ileal end-to-side anastomosis

Learning Points:

• Complete fundus dissection to warrant a correct sleeve gastrectomy – use wide bougie, avoid strictures

• Long duodenal dissection with preservation of pyloric vascularization and innervation

• Distal to proximal measurement of the small bowel to know the exact length of the common limb

• Take your time to perform a safe anastomosis