Abstract Introduction This video article presents the case of a 43-year-old female with morbid obesity (BMI 48 kg/m²) and severe anaemia (Hb 7.3 g/dL), prompting an upper GI endoscopy. The endoscopy revealed two gastric polyps: one large polyp (2.5 × 3 cm) along the greater curvature and a smaller (0.5 × 1 cm) polyp in the antrum. Both were diagnosed as chronic hyperplastic polyps. Sleeve bipartition (Single anastomosis sleeve jejunal bypass SASJ) was selected to manage her morbid obesity, with a laparoscopic transgastric approach utilized to ensure precise localization and excision of the polyps. Case presentation The patient presented with morbid obesity and severe anaemia, with an upper GI endoscopy confirming two chronic hyperplastic polyps in the stomach. The larger polyp was located along the greater curvature, while the smaller was antral. Furthermore, colonoscopy was done but was unremarkable. Given her metabolic complications, sleeve bipartition was chosen to address weight reduction, metabolic improvement, and safe polyp removal. Surgical technique This video illustrates the procedure, beginning with a laparoscopic transgastric approach to assess the exact locations of both polyps. Gastrectomy was then performed with the staple line placed medial to both polyps, ensuring they were included in the excised portion of the stomach. Following this, sleeve bipartition was completed, providing both metabolic benefits and effective lesion removal. The excised specimens were sent for histopathological analysis. Postoperative outcomes The patient recovered well, with a prompt return to oral intake and minimal complications. At her 6-month follow-up, she had achieved a 28% excess weight loss and showed significant improvements in anaemia and metabolic parameters. Histopathology confirmed that the large polyp along the greater curvature was neuroendocrine tumour, and the smaller antral polyp was benign hyperplastic. Conclusion This case demonstrates the utility of sleeve bipartition combined with a laparoscopic transgastric approach to manage complex cases of morbid obesity with concurrent gastric polyps. The technique allowed precise identification and exclusion of polyps within the excised gastric portion, optimizing both metabolic and pathological outcomes. This video provides insights into the approach and its potential applications in similar cases. Note for submission This video article will focus on the dual benefits of sleeve bipartition and the innovative use of a laparoscopic transgastric approach for polyp assessment and excision, highlighting intraoperative techniques and postoperative outcomes.
Mokhtar et al. (Thu,) studied this question.