We present a new 2-step strategy for Roux-n-Y gastric bypass (RYGB) conversion to Single Anastomosis Duodenoileal bypass-Sleeve gastrectomy (SADI-S). Gastro-gastric anastomosis (GGA) and sleeve gastrectomty (SG) are planned in 2 separate surgeries in order to tackle SG in a less inflammatory tissue situation and staple over a complete re-vascularized gastric tissue.


We present a 50-years-old woman who underwent a 150x250cm RYGB (BMI; 45Kg/m2) in 2013. During follow-up, the minimum BMI reached was 19.89Kg/m2. She later regained weight, (BMI; 39Kg/m2). Consequently, a 2-step approach of SADI-S conversion was proposed. The preoperative study dismissed gastrojejunal anastomosis (GJA) or pouch dilation.


First surgery (SADI): The GJA was dissected and the mechanical GGA was performed. The common channel was 450cm; therefore, the alimentary limb was resected. Afterwards, the mechanical SADI was done at 250cm from the ileocecal valve.She was discharged on the 5th day. At 6 months after surgery, the patient lost 10Kg (BMI; 34.5Kg/m2). The new endoscopy proofed normal gastric restoration.Second Surgery (SG): We verified that revascularization and reshaped stomach were correct. SG was performed with 54Fr bougie without any difficulties.The patients was discharged uneventfully on the 5th day.


A 2-step approach revisional SADI-S is a safer option to achieve an outstanding SG and avoid surgical complications such as gastric leaks due to multiple staple lines crossings. Six months lapse time allows endoscopic control to confirm gastric mucous normality and it might provide the best environment to normally shape the SG.