TITLE:
SADI-S with Extended Duodeno-Bulb Preservation: Case Report
AUTHORS:
Victor Ramos Mussa Dib, Carlos Augusto Scussel Madalosso, Paulo Reis Esselin de Melo, Rui Ribeiro, Gabriela Trentin Scortegagna, Elinton Adami Chaim
KEYWORDS:
Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy, Obesity, Bulb Preservation, Bariatric Surgery, Metabolic Surgery
JOURNAL NAME:
Surgical Science,
Vol.14 No.2,
February
27,
2023
ABSTRACT: Obesity has been growing in Brazil and in the world. It is reaching
epidemic proportions, and bariatric surgery is the most effective treatment for
patients with this disease. Among the procedures described in the literature,
ileal surgeries such as biliopancreatic diversion with duodenal switch (BPD-DS)
and single-anastomosis duodeno-ileal bypass
with sleeve gastrectomy (SADI-S) present better long-term results in terms of weight
loss and comorbidities control. However, there are concerns regarding
long term nutritional problems with
these procedures. In this case report the aim is to demonstrate the technical
feasibility of preserving an extended duodenal bulb segment, in the SADIS-S procedure, when there are difficulties in
dissecting the retrobulbar region, as occurred here, due to fibrosis in this
area. This assures the maintenance
of the proposed surgical technique, in such a situation. The dissection and
transection of the duodenum was done 7 cm distally to the pylorus, under
endoscopic view, proximally to the papillae, where the tissue was normal.
Additionally, due the importance of the duodenal mucosa on minerals and trace
elements absorption and the release of important hormones in this region, this
case report elicits the evaluation of the impact of this technical modification, which occurred casually, in the nutritional, hormonal and metabolic results,
long term. In this case report, the extended duodenal length has demonstrated
reasonable weight loss, adequate comorbidities control and good nutritional
status, so far. These aspects must be evaluated in the long term, by clinical
trials.