IBC-Oxford University2023_BJSOral_11Video Presentation: Laparoscopic Total Gastrectomy after Single Anastomosis Sleeve Jejunal Bypass

Abstract

Abstract Introduction Amongst today's bariatric surgery procedures is the single anastomosis jejunal bypass operation (SASJ), which was first introduced by Professors Abdolreza Pazouki and Mohammad Kermansaravi. Single anastomosis sleeve ileal bypass (SASI) is a combined bariatric metabolic technique, in which few studies have shown its outcomes efficacy. However, this technique has a high risk of malnutrition due to long biliopancreatic limb. Single anastomosis sleeve jejunal bypass (SASJ) has a shorter limb. Therefore, it seems to have a lower risk of nutrient deficiency. Furthermore, this technique is relatively new, and little is known about the efficacy and safety of SASJ. Obesity is a significant risk factor for cancer incidence and mortality. The number of patients with obesity who undergo bariatric surgery is increasing; however, the impact of such a procedure in affecting the risk of cancer is not completely understood yet. The association between obesity and malignancies has been identified epidemiologically. Meanwhile, the increasing global number of bariatric surgeries is reported annually; bariatric surgery’s effect on different types of cancers is not well understood. Unfortunately, nonspecific presentations and difficulties regarding investigations make diagnosis challenging. Methods In this video case report, the patient was 62-year-old female with an initial BMI 44.2 kg/m2, weight: 116 kg and Height: 162 cm at the time of SASJ 6 years ago, upper gastrointestinal Endoscopy from 2017 before SASJ operation showed reflux esophagitis grade A and erosive erythematous hyperaemic mucosa gastritis. She underwent primary laparoscopic SASJ bypass in 2017. However, she had adequate weight loss for 5 years post-operative, and then she had excessive weight loss during past year. According to the patient history she suffers heart burn, anorexia, nausea and vomiting since1 year back, usually vomiting is present 2 hours postprandial with dark and black coloured content, and now her BMI is 21kg/m2. She had an upper GI endoscopy during past year, the last endoscopy report in 2023 commented on active and focally ulcerative mucosa with some atypical cells with signet ring pattern and chronic inflammatory responses, and biopsy showed adenocarcinoma of the stomach. Thorax, abdomen and pelvic CT scans were normal with no pathology is seen in upper GI contrast study. Laboratory findings were normal. A Laparoscopic Roux-en Y oesophago-jejunal bypass with a 75cm biliopancreatic limb and 75cm alimentary limb were performed. The patient was under complete screening for all over the last 1 so surgery is performed in first after confirmation of histopathology report before chemoradiotherapy (CRT). Results The operative time was 210 min and blood loss were 150ml. There were no intraoperative or postoperative complications. The patient had an uneventful postoperative course and was discharged on postoperative day 8. Conclusion Laparoscopic total gastrectomy with dissection of all lymph node from gastric stations is performed prior to the chemoradiotherapy for reaching the purpose of early malignancy control.