Background

Introduction: We present a video case report of a patient undergoing successful robotic enterolysis and gastro-enteropexy to treat symptomatic retrograde filling of the afferent limb following robotic SADI-S. Presentation of case: A 58-year-old man presented to the ER with recurrent episodes of post-prandial nausea and vomiting 2 months after undergoing robotic SADI-S. An UGI showed preferential retrograde filling of the afferent limb with simultaneous development of symptoms after the contrast was ingested. A robotic diagnostic laparoscopy was performed after conservative management failed. Management: Laparoscopy showed adhesions that pulled the efferent limb just distal to the anastomosis cranially while the afferent limb lied in a dependent position. Adhesiolysis of the anastomosis and pexy of the afferent limb to the antrum was performed. Symptoms resolved and the patient was discharged home tolerating a full liquid diet the next day. He has remained symptom free during follow up. Discussion: Symptomatic retrograde filling of the afferent limb is an uncommon complication caused by adhesions pulling the efferent side of the anastomosis in a cranial direction which causes preferential filling of the afferent limb after liquid or food ingestion. Symptoms resemble those of dietary indiscretion or partial bowel obstruction and include post-prandial nausea, vomiting, and abdominal pain. Initial treatment is conservative, but failure requires additional work-up and sometimes surgical intervention. Gastro-enteropexy of the afferent limb prevents it. Conclusion: Symptomatic retrograde filling of the afferent limb after SADI-S is an unusual complication that can be confirmed by UGI. Surgery is needed if conservative treatment fails.