Background

The simple nature of sleeve gastrectomy as well as its confinement to the upper abdomen makes it a favorable bariatric surgery choice in patients with multiple prior abdominal surgeries. We report on a case of sleeve gastrectomy performed on a patient with severely complex abdominal anatomy.

Methods

A 45-year-old female with medically complicated obesity (BMI=44 kg/m2), a history of 52 prior abdominal procedures (fistula takedowns, open abdomens, intestinal resection, washouts), and a wide abdominal hernia (~20cm) presented for sleeve gastrectomy as a bridge to hernia repair. Optiview access at Palmer’s point was complicated by colonic injury. Hasson entry in the right upper quadrant was performed and careful lysis of adhesions followed. The colotomy was repaired and the sleeve was tailored over a 40 F bougie.

Results

The patient had an uneventful hospital stay and was discharged on postoperative day 3. On 30-day follow-up, the patient had no complaints, was progressing with diet as tolerated, and was found to have a BMI=35.48 kg/m2.

Conclusions

Sleeve gastrectomy remains the ideal bariatric surgery option in patients with a difficult abdomen unless otherwise contraindicated.