Pablo Quadri1, Mario Masrur, MD1, Lisa Sachez-Johnsen, PhD1, Enrique F Elli, MD2. 1University of Illinois at Chicago, 2Mayo Clinic Florida
Introduction: Biliopancreatic diversion (BPD) with duodenal switch is a second line treatment for morbid obesity and must be considered when other procedures have failed. It contributes to less than 2% of all bariatric surgeries worldwide.
Case Presentation: The patient is a 53-year-old woman with history of hypertension, type 2 diabetes, asthma, hyperlipidemia, cholecystectomy and appendectomy. Her BMI at the time of the BPD was 50.7 kg/m2. She had tried several medical treatments for weight loss and had a sleeve gastrectomy in 2009, had inadequate weight loss. She was offered the option of undergoing a minimally invasive robotic-assisted biliopancreatic diversion with duodenal switch. The procedure started with the identification of ileocecal valve. The small bowel was run 130 cm and marked with a 3-0 silk to identify the site of the jejuno-jejunostomy. Another 120 cm were run from the silk where small bowel was transected with a stapler. The distal end was marked with a 3-0 PDS suture. The biliopancreatic end of the small bowel was anastomosed latero-laterally with a stapler at the 130 cm mark. The enterotomies were closed with 0 PDS in two layers. Then, the robot was docked. The duodenum and common bile duct were dissected and retro-duodenal tunnel was performed in the first portion. The duodenum was transected using a stapler. The vascular supply of the proximal duodenum and the stump were checked using the Firefly Fluorescent System. The jejunum marked with the PDS was brought in a supracolic fashion to the proximal duodenum for the anastomosis. A running posterior outer layer was performed with 3-0 PDS. Then the enterotomies were performed. The posterior inner layer and the anterior double layer were sutured with running 3-0 PDS. The mesenteric gap was then closed. An intraoperative endoscopy was performed. Operative time was 153 minutes. There were no complications. Patient was discharged on POD 5.
Conclusions: The robotic platform appeared to be safe and effective for her complex bariatric surgery. This case report, built upon prior studies, demonstrates that BPD with duodenal switch may be considered as a second stage surgery for patients with inadequate weight loss.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80339
Program Number: V112
Presentation Session: Friday Exhibit Hall Video Presentations Session 3 (Non CME)
Presentation Type: EHVideo