Background

Due to the technically challenging nature and risk of internal herniation associated with Roux-en-Y Gastric Bypass (RNYGB), procedures like Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) are gaining momentum. SADI-S employs a single anastomosis, and utilizes pyloric preservation to alleviate bile reflux which is a common drawback of other simpler alternatives to RNYGB such as One Anastomosis Gastric Bypass (OAGB). In the literature investigating efficacy and safety outcomes of SADI-S, reports of internal hernia are sparse and the risk is considered low.

Methods

32-year-old male with initial BMI of 56 kg/m2, history of one-step robotic SADI-S, presented 3 years post-operatively with new-onset post-prandial pain, nausea and PO intolerance. His initial work-up for biliary etiology/obstruction/internal herniation was unremarkable radiologically. He ultimately underwent exploratory laparoscopy and was noted to have a 180-degree twisting of his anastomosis and internal herniation of small bowel loops in the iatrogenic window between the ileal loop of the anastomosis and root of the mesentery. The bowel was reduced, and mesenteric window closed with running permanent suture. Patient's presenting symptoms resolved post-operatively.

Conclusions

Although there is sufficient emerging data on SADI-S being comparable to RNYGB for weight loss and metabolic outcomes, long-term outcomes data regarding secondary complications and reasons for reoperation is sparse due to SADI-S being a relatively newer procedure. We describe a case of internal herniation following SADI-S, and its surgical treatment.