Bowel reconstruction after single anastomosis duodenal‑ileal bypass

Single‑anastomosis duodenal‑ileal bypass with sleeve gastrectomy (SADI‑S) is a relatively new bariatric surgery procedure, which is ether as a first stage bariatric procedure or second stage surgery following sleeve gastrectomy, or a revisional procedure for unsatisfied weight loss or weight regain following sleeve gastrectomy. Usually the duodenal‑ileal anastomosis in SADI‑S procedure is made at 250 cm to 300 cm from ileocecal valve. However, as the whole bowel length is quite different, a fixed measurement of only biliopancreatic limb or common limb could result in either too short or too long absorptive bowel leading to life‑threatening nutritional deficiencies on the one hand, or insufficient weight loss on the other. In response to this issue, the author proposes to determine the position of anastomosis based on the ratio of common limb length and total bowel length, in order to achieve satisfactory weight loss and avoid malnutrition complications.