Clinical Scorecard: Initial Experience and Technique of Single-Port One Anastomosis Sleeve Gastrectomy with Transit Bipartition
At a Glance
Category
Detail
Condition
Obesity with or without type 2 diabetes mellitus (T2DM) and gastroesophageal reflux disease (GERD)
Key Mechanisms
Sleeve gastrectomy combined with transit bipartition creating a dual delivery system to reduce nutritional complications and improve metabolic outcomes
Target Population
Patients with obesity, T2DM, GERD, history of constipation, or family history of gastric tumor; excluding those planning pregnancy
Care Setting
Specialized bariatric surgery centers with laparoscopic single-port surgical capability
Key Highlights
Single-port one anastomosis sleeve gastrectomy with transit bipartition (SG-OATB) is feasible and safe based on initial experience with three patients.
SG-TB offers benefits including weight reduction, metabolic syndrome improvement, and GERD symptom improvement.
Single anastomosis technique reduces postoperative gastrointestinal complications by avoiding mesenteric defects compared to Roux-en-Y.
Guideline-Based Recommendations
Diagnosis
Assess patient history including T2DM status, GERD grading, constipation history, and family history of gastric tumors.
Perform preoperative endoscopy to evaluate esophagitis and gastric mucosa status.
Measure fasting blood glucose and HbA1c levels preoperatively.
Management
Perform sleeve gastrectomy starting 6 cm from the pylorus with full-layer staple line reinforcement.
Measure total small bowel length intraoperatively and maintain 55–60% of small bowel as common limb for anastomosis.
Create a single anastomosis approximately 3 cm from the pylorus with a width of about 2.5–3 cm.
Use single-port laparoscopic technique with Quadri-port trocar for access.
Close anastomosis defect carefully with sutures ensuring mucosal apposition.
Monitoring & Follow-up
Monitor patients postoperatively for 30 days for complications and readmission.
Discharge patients typically by postoperative day 4 if stable.
Follow up on metabolic parameters and GERD symptoms postoperatively.
Risks
Potential technical difficulty in closing the anastomosis defect due to limited instrument angulation in single-port approach.
Risk of GERD and esophagitis requiring preoperative assessment and management.
Nutritional complications minimized by dual delivery system but require ongoing monitoring.
Patient & Prescribing Data
Three patients (two female, one male) with obesity and varying T2DM and GERD status, no prior bariatric surgery
All patients tolerated single-port SG-OATB without conversion to multiple-port; no 30-day readmissions; procedure duration ranged 150–200 minutes; effective small bowel measurement and anastomosis creation feasible via single-port
Clinical Best Practices
Obtain detailed informed consent discussing pros and cons of SG, gastric bypass, and SG-TB procedures.
Exclude patients planning future pregnancy from SG-TB procedure.
Use a 36-Fr bougie for sleeve gastrectomy and reinforce staple line with full-layer sutures.
Maintain common limb length at 55–60% of total small bowel length for optimal metabolic outcomes.
Employ careful suturing technique to close anastomosis defect ensuring mucosal integrity.
Place abdominal drainage routinely and monitor closely postoperatively.
