Background

A 47-year-old female patient presented with severe malnutrition and liver failure. She first underwent sleeve gastrectomy and then faced weight recurrence. Then she underwent a malabsorptive procedure (SADI-s) abroad. She suffered from moderate protein malnutrition and was unable to maintain nutrition through oral intake alone. CT scan showed severe steatohepatitis and massive ascites. And liver biopsy was then performed. Liver biopsy revealed severe steatohepatitis of metabolic etiology. The priority was to improve her condition. So, we placed a surgical J tube for additional tube feeding. After several months, her liver function and nutrition improved. Finally the decision was made to reverse the malabsorptive components of SADI-s. Her common channel was 200cm, BP limb was 500cm. We divided the long BP limb right before the duodenoileostomy and the ileum 100cm distal to the duodenoileostomy. Then we made a short BP limb of 50cm, a long common channel of 550cm. The proximal part of the divided ileum was used as the Roux limb, so the length of Roux limb was 100cm. The estimated blood loss was 20mL and no drain was inserted. She recovered well and was discharged to home on the second postoperative day. Several weeks after surgery, she is able to maintain her nutrition through oral intake alone and her blood chemistry shows normal values. She will need regular check-ups, but she is satisfied with her current condition.