Stapling Through a Bougie During Sleeve Gastrectomy in a Superobese Patient-a Video Vignette

Obes Surg. 2020 Oct;30(10):4167-4168. doi: 10.1007/s11695-020-04790-z. Epub 2020 Jul 2.


Purpose: Bariatric-metabolic surgery in superobese patients (BMI > 50 kg/m2) is very challenging indeed with little room for error. In many cases, a two-step procedure is required, since more complex primary bariatric procedures can be technically demanding and bearing a relevant risk for the patient. At our institution, laparoscopic sleeve gastrectomy (SG) is the preferred primary procedure, followed by a conversion to either SADI-S or Roux-en-Y gastric bypass (RYGB) after initial weight loss is achieved [1, 2]. This video aims at demonstrating the conversion from primary SG to RYGB due to an adverse event in a 45-year-old superobese female patient (weight, 170 kg; BMI, 73 kg/m2).

Methods: An intraoperative laparoscopic video has been anonymized and edited to demonstrate the course of the operation on the patient mentioned above.

Results: The start of the procedure was uneventful. After a successful mobilization of the greater curvature, the stomach was resected with an electronic stapling device guided by a firm 36-french bougie (Rüsch, Germany) towards the angle of His. Due to a limited view, a stapler was placed over the bougie, which resulted in the stomach being subtotally transected, the staples attaching the bougie to the sleeve about 5 cm from the gastroesophageal junction. Salvage surgery after removing the remnants of the bougie was a conversion to RYGB.

Conclusion: When performing a bariatric-metabolic surgery in superobese patients, an extended skill level is required to provide a solution, should anything go wrong. Therefore, we suggest bariatric-metabolic surgery in superobese patients to be performed solely and specifically at high-volume centres.

Keywords: Bougie; RYGB; Sleeve gastrectomy; Video vignette.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Video-Audio Media

MeSH terms

  • Female
  • Gastrectomy
  • Gastric Bypass*
  • Germany
  • Humans
  • Laparoscopy*
  • Middle Aged
  • Obesity, Morbid* / surgery
  • Retrospective Studies
  • Weight Loss