The first case report of failed single-anastomosis-duodeno-ileal bypass converted to One anastomosis gastric bypass/Mini-gastric bypass

Sonja Chiappetta; Christine Stier; Oliver Scheffel; Sophia Theodoridou; Rudolf Weiner

doi:10.1016/j.ijscr.2017.04.020

The first case report of failed single-anastomosis-duodeno-ileal bypass converted to One anastomosis gastric bypass/Mini-gastric bypass

Int J Surg Case Rep. 2017:35:68-72. doi: 10.1016/j.ijscr.2017.04.020. Epub 2017 Apr 18.

Authors

Sonja Chiappetta¹, Christine Stier², Oliver Scheffel³, Sophia Theodoridou⁴, Rudolf Weiner⁵

Affiliations

¹ Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach/Main, Germany. Electronic address: drschiappetta@gmail.com.
² Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach/Main, Germany. Electronic address: christinestier@googlemail.com.
³ Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach/Main, Germany. Electronic address: docscheffel@gmail.com.
⁴ Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach/Main, Germany. Electronic address: SophiaTheodoridou@t-online.de.
⁵ Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach/Main, Germany. Electronic address: profweiner@gmail.com.

Abstract

Introduction: The established single-anastomosis-duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is based on a sleeve gastrectomy (SG) as the restrictive part of the procedure. Due to preserved pylorus, SG has the disadvantage of a high-pressure system with de novo or worsening of existing gastroesophageal reflux disease (GERD).

Case presentation: A female patient presented herself due to protracted GERD and weight regain after multiple bariatric surgeries. At an initial weight of 158kg (BMI 62.5kg/m²) the patient underwent adjustable gastric banding in 2009. After band removal in slippage, the patient underwent SG at a weight of 135kg in 2012. Nine months after SG, SADI-S was performed as a malabsorptive second step procedure. After 32 months the patient suffered from severe GERD under proton pump inhibitor therapy. Actual weight was 107.9kg (BMI 42.7kg/m²). Upper endoscopy showed a hiatal hernia and esophagitis B and dorsal hiatoplasty was performed. After 6 months in still existing severe GERD and weight regain indication for laparoscopic conversion to One anastomosis gastric bypass/Mini-gastric bypass (OAGB/MGB) was given, aiming to reduce the high-pressure system of SG in a low-pressure system of OAGB/MGB. One year after revisional surgery reflux was reported to be only occasionally. Further weight loss was seen (91kg, BMI 36kg/m², EWL 67.7%).

Conclusion: SG as the restrictive part of SADI-S may lead to GERD and consequently to pathologic eating of "soft" calories, that defeats the operation and results in weight regain. OAGB/MGB might be a simple method to rescue such failed SADI-S patients.

Keywords: Case report; GERD; OAGB/MGB; Revisional surgery; SADI-S; Weight regain.