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<p>Robotic Single Anastomosis Sleeve Ileal (R-SASI) Bypass is an effective bariatric procedure with promising outcomes but potential complications, including rare Afferent Loop Syndrome (ALS). This report highlights ALS management post-R-SASI, emphasizing surgical revision to address altered gastrointestinal anatomy and ensure patient recovery. In this video report, the patient was a 35-year-old Asian female with class III obesity, hypertension, and metabolic syndrome. She underwent Robotic Single Anastomosis Sleeve Ileal (R-SASI) Bypass. Postoperatively, afferent loop syndrome due to sleeve-ileal anastomosis obstruction caused bile vomiting and abdominal fullness, necessitating successful reoperation for resolution. Revisional surgery addressed acute angulation at the sleeve-ileal anastomosis, causing intestinal obstruction post-R-SASI. Steps included releasing tension, repositioning the efferent limb, serosa fixation, Braun enteroenterostomy, and mesentery defect closure. The 120-minute procedure was complication-free, with smooth recovery, allowing discharge on postoperative day 4. R-SASI bypass is an effective bariatric procedure for weight loss and metabolic improvement but carries a risk of complications like mechanical bowel obstructions. Additional anastomotic fixation may prevent obstructions and enhance outcomes. Further research is needed to optimize techniques.</p>

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Complication of Afferent Loop Syndrome(ALS) Post Robotic Single Anastomosis Sleeve Ileal (R-SASI) Bypass and Management with Laparoscopic Revision (Video Report)

  • 期刊论文

  • 发表日期：

    2026年2月25日

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  • Yi-Jie Wang,
  • Hsiang Teng,
  • Hsin-Mei Pan,
  • Kuo-Feng Hsu

摘要

Robotic Single Anastomosis Sleeve Ileal (R-SASI) Bypass is an effective bariatric procedure with promising outcomes but potential complications, including rare Afferent Loop Syndrome (ALS). This report highlights ALS management post-R-SASI, emphasizing surgical revision to address altered gastrointestinal anatomy and ensure patient recovery. In this video report, the patient was a 35-year-old Asian female with class III obesity, hypertension, and metabolic syndrome. She underwent Robotic Single Anastomosis Sleeve Ileal (R-SASI) Bypass. Postoperatively, afferent loop syndrome due to sleeve-ileal anastomosis obstruction caused bile vomiting and abdominal fullness, necessitating successful reoperation for resolution. Revisional surgery addressed acute angulation at the sleeve-ileal anastomosis, causing intestinal obstruction post-R-SASI. Steps included releasing tension, repositioning the efferent limb, serosa fixation, Braun enteroenterostomy, and mesentery defect closure. The 120-minute procedure was complication-free, with smooth recovery, allowing discharge on postoperative day 4. R-SASI bypass is an effective bariatric procedure for weight loss and metabolic improvement but carries a risk of complications like mechanical bowel obstructions. Additional anastomotic fixation may prevent obstructions and enhance outcomes. Further research is needed to optimize techniques.