The single-anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S) can be performed in a single stage or two stages. The two stages include performing a sleeve gastrectomy (SG) first, and then adding a loop duodeno-ileostomy (DI) to the existing SG. Sleeve stricture is one of the infrequent chronic complications associated with SG. However, of all the complications of SADI-S, sleeve stricture is one of the most common long-term complications seen with SADI-S. A sleeve stricture at the incisura of the sleeve can cause gastric outlet obstruction (GOO). Sleeve stricture can be treated using pneumatic dilation. However, repeated pneumatic dilations can complicate the case further by compromising the tenuous tissue of a strictured stomach due to scaring and blood supply. In patients with failed pneumatic dilations, surgical correction is the ultimate choice.
Purpose: The study aimed to present our surgical technique of performing loop gastro-jejunostomy (GJ).Materials and Methods: In this video report, we present a case of a 36-yr-old female patient with a BMI of 52.5 kg/m2 who underwent a two-staged laparoscopic SADI-S procedure for morbid obesity and developed a sleeve stricture causing GOO. We decided to perform a loop GJ to treat the GOO in this patient.Surgical Technique. Our surgical technique is shown in the video.
The blood loss was five cc. The operating time was 90 mins. No intraoperative complication occurred.
A loop GJ preserves the blood supply to the SG while alleviating the obstruction of a chronic stricture.