Initial Experience and Technique of Single-Port One Anastomosis Sleeve Gastrectomy with Transit Bipartition
Overview
This study reports the first clinical experience performing single-port one anastomosis sleeve gastrectomy with transit bipartition (SG-OATB) in three patients. The procedure was feasible, safe, and showed no need for conversion to multiple ports, with all patients discharged by postoperative day 4 and no 30-day readmissions.
Background
Sleeve gastrectomy with transit bipartition (SG-TB) is an emerging bariatric technique that offers significant weight loss and metabolic improvements, including benefits for type 2 diabetes mellitus (T2DM) and gastroesophageal reflux disease (GERD). The single anastomosis approach simplifies the procedure compared to Roux-en-Y and may reduce postoperative complications. While single-port techniques have been widely used in bariatric surgery, their application in SG-TB had not been previously reported. This study aims to describe the initial experience and technical aspects of single-port SG-OATB.
Data Highlights
Parameter
Patient 1
Patient 2
Patient 3
Age (years)
38.7 ± 5.5 (mean)
Weight (kg)
105.7 ± 5.4 (mean)
Height (m)
1.64 ± 0.11 (mean)
BMI (kg/m2)
39.3 ± 4.7 (mean)
FBG (mmol/L)
7.2
Not diabetic
Not specified
HbA1c (%)
7.4
Not diabetic
Not specified
GERD-Q Score
6.3 ± 1.5 (mean)
High
Not specified
Preoperative Endoscopy
Esophagitis Grade A
Esophagitis Grade B + Hiatal Hernia
Atrophic Gastritis (Kimura-Takemoto C1)
Total Small Bowel Length (cm)
720
730
750
Anastomosis Location from Treitz (cm)
300
300
400
Procedure Duration (min)
150
200 (with hiatal hernia repair)
160
Postoperative Day of Discharge
4
4
4
30-day Readmission
0
0
0
Key Findings
Single-port SG-OATB was successfully performed in three patients without conversion to multiple ports.
The procedure duration ranged from 150 to 200 minutes, with the longest time including hiatal hernia repair.
Small bowel measurement and gastrointestinal anastomosis were feasible despite single-port angulation limitations.
Closure of the anastomosis defect was the most technically challenging step due to limited instrument angulation.
All patients were discharged by postoperative day 4 with no 30-day readmissions, indicating good short-term safety.
Preoperative patient selection included T2DM, GERD, constipation history, and family history of gastric tumors, with pregnancy desire as an exclusion criterion.
Clinical Implications
The single-port SG-OATB technique is a feasible and safe minimally invasive option for selected bariatric patients, potentially reducing surgical trauma and postoperative complications associated with multiple ports. Surgeons should anticipate technical challenges during anastomosis defect closure and prepare accordingly. Patient selection remains critical, especially considering metabolic comorbidities and GERD status.
Conclusion
This initial experience demonstrates that single-port SG-OATB is a technically feasible and safe procedure with promising short-term outcomes. Further studies with larger cohorts are needed to validate these findings and assess long-term efficacy.
References
Santoro et al. 2023 -- Sleeve Gastrectomy with Transit Bipartition Outcomes
