Bile Reflux following Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) and its Surgical Treatment

| January 1, 2022

by Amit Surve, MD; Daniel Cottam, MD; and Walter Medlin, MD, FACS 

Drs. Surve, Cottam, and Medlin are with Bariatric Medicine Institute in Salt Lake City, Utah. 

Funding: No funding was provided for this article.

Disclosures: Dr. Cottam is part of the speaker bureau for Medtronic and has been awarded a research grant by Medtronic for the study of Duodenal Switch. The other authors have no conflicts of interest relevant to this article.

Bariatric Times. 2022;19(1):10.


Abstract

Bile reflux following the single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) procedure is rare. If it occurs, it can be fixed easily with surgical treatment. In this video case report, we present a case of a 58-year-old female patient who experienced bile reflux gastritis following SADI-S and its surgical treatment. 

Keywords: Bile reflux, single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S), surgical treatment, surgical technique, abdominal pain, bariatric


Bile reflux following the single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) procedure is rare.1 The reported incidence of bile reflux following the SADI-S procedure is 0.1 percent.1 

Purpose

The study aimed to demonstrate a surgical treatment for bile reflux following SADI-S.

Materials and Methods

In this video case report, we present a case of a 58-year-old female patient who underwent a SADI-S procedure for morbid obesity. Nine months postoperatively, the patient started experiencing bile reflux gastritis and abdominal pain. A similar case of bile reflux following SADI-S has already been reported in the literature; however, the cause of bile reflux in that case was an internal hernia.2 In the present report, an upper gastrointestinal series revealed partial bowel obstruction, causing the contrast to enter into the afferent limb. We decided to perform an exploratory laparoscopy. 

Surgical technique. The surgical treatment is shown in the video. At the time of the surgery, we found that the afferent limb-stay suture had come out, and the afferent limb was in a dependent position such that all food would primarily go into the afferent limb. We tried fixing the relative obstruction by reorienting the duodeno-ileostomy (DI) as it was at the time of the primary procedure. However, to make sure bile reflux did not occur, we also created an enteroenterostomy 15cm below the DI. 

Results

The blood loss was 5cc. No intraoperative complication was noted. The operative time was 18 minutes. The length of stay was one day. One month postoperatively, the patient had no complaints. 

Conclusion

Bile reflux can occur months to years after SADI-S. If it occurs, it can be fixed easily with surgical treatment.  

References

  1. Surve A, Cottam D, Sanchez-Pernaute A, et al. The incidence of complications associated with loop duodeno-ileostomy after single-anastomosis duodenal switch procedures among 1328 patients: a multicenter experience. Surg Obes Relat Dis. 2018;14(5):594–601. 
  2. Surve A, Cottam D, Horsley B. Internal hernia following primary laparoscopic SADI-S: the first reported case. Obes Surg. 2020;30(5):2066–2068.

 

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Category: Case Report, Current Issue

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