Conversion of a Previously Reversed Roux En Y Gastric Bypass to a Sleeve Gastrectomy for Morbid Obesity and Pseudotumor Cerebri

Soto Flavia, Elias Chousleb, Omar Bellorin, Ismael Court, Abraham Abdemur, Samuel Szomstein. Cleveland Clinic Florida

Reversing weight loss operations, usually leads to recurrence of obesity and associated co-morbidities. Reoperative choices for recurring obesity are few and complex to be performed via laparoscopy.

Case presentation and methods: We present the case of a 43 y/o female who had previously undergone a gastric bypass RYGB (1998) for the treatment of morbid obesity (MO). The RYGBP required reversal (1999) due to severe vomiting, malnutrition and metabolic complications a year later. At the time of consultation the patient had a BMI of 43.5. Her co-morbid conditions were DVT’s, DM, PE, CVA and Pseudotumor cerebri which required ventriculoperitoneal shunts to manage her intracranial hypertension. After a lengthy discussion with the patient it was decided to perform a sleeve gastrectomy (LSG). Using a laparoscopic approach with a seven port technique, extensive lysis of adhesions was performed. During this step of the operation one of her previously placed VP shunts was partially cut and repaired. After complete identification of anatomy of the upper abdomen, a sleeve gastrectomy was performed over a 38 Fr. bougie. All staple lines where oversewn and the specimen retrieved. Patient recovered uneventfully and was discharged home on POD # 5.

LSG can be safely performed as a reoperative treatment option for weight loss after weight regain and recurrence of co morbid conditions in patients that had their previous operations reversed. Long term results are necessary to support this approach to be proven valid.

Session: VidTV1
Program Number: V054

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