IBC Oxford Poster Abstract 18 - Management of severe complications after single anastomosis stomach–ileal bypass with sleeve gastrectomy: a case series report

Abstract Introduction Single Anastomosis Stomach–Ileal Bypass with Sleeve Gastrectomy (SASI-S) is a novel bariatric procedure associated with a low incidence of severe complications. Reported rates include an anastomotic leak rate of 0.41% and a surgical conversion rate of approximately 7.9%, primarily in patients experiencing excessive weight loss or malnutrition Case report Case 1: 46-year-old female who underwent a SASI-S seven days prior to presentation. Upon assessment, panniculitis, free intraperitoneal air, a splenic hematoma, intrahepatic collections, and a left basal pleural effusion were found. An exploratory laparoscopy identified a 3 cm gastric fistula along the anastomotic suture line, requiring the placement of an endoscopic self-expanding stent, without significant improvement. Therefore, a resective Roux-en-Y gastric bypass (RYGB) was performed 36 days after the initial surgery. Ten days later, two additional fistulas were found and managed with pigtail catheters and a jejunostomy. The patient was discharged 69 days post-initial surgery with enteral feeding. Case 2: 62-year-old female who underwent a SASI-S procedure three months prior to presentation. The patient presented solid food intolerance, nausea, vomiting, diarrhoea with faecal incontinence, dumping syndrome, significant dehydration, and umbilical wound infection with sepsis. An upper endoscopy revealed faecaloid reflux into the oesophagus, a narrow gastric sleeve, and a patent gastroileal anastomosis. Intraoperatively, the ileal segment involved in the anastomosis was resected, and the gastric and intestinal defects were closed performing a reversal to a sleeve gastrectomy; finally, the purulent fluid from the umbilical wound was drained. Enteral feeding was reintroduced and the patient was discharged 5 days after the procedure. Discussion These cases illustrate rare but severe complications following SASI-S that required surgical reintervention. In the first case, an endoscopic stent was used as a less invasive initial approach to manage the leak. While stents achieve complete fistula healing in approximately 70% of cases, they carry a high risk of migration, estimated at 53%, as occurred in this patient, ultimately necessitating conversion to a RYGB. Additionally, the second case highlights the importance of clinical optimization prior to surgical revision. Treatment with total parenteral nutrition (TPN) and antibiotics led to a successful reversal of the SASI-S and restoration of enteral nutrition.