Revisional Bariatric Surgery: From Gastric Band to Robotic Assisted-laparoscopic Sleeve Gastrectomy

S Ayloo, MD FACS, F Gheza, MD, M Masrur, MD, D Calatayud, MD PhD, P C Giulianotti, MD FACS. Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA.


Despite the increasing number of adjustable gastric banding procedures in US, 20% removal of bands mostly for inadequate loss of weight has been reported with increasing incidence of revisional bariatric surgery. The video show cases all the essential steps of robot assisted laparoscopic conversion from gastric banding to Sleeve gastrectomy.
43-year old woman who had a laparoscopic adjustable gastric band placed five years ago with 10 different adjustments and a current BMI of 44, failed in achieving adequate weight loss presented for revisional bariatric surgery. Patient was committed to proceeding with robot assisted laparoscopic sleeve gastrectomy.
Pneumoperitoneum was achieved and a diagnostic laparoscopy was performed. The procedure started by dissecting the gastrocolic ligament and taking down all the vascular supply around the greater curvature of stomach up until the left cruz and distally to about 5 cm to pylorus. The capsule around the gastric band was dissected and the band was then cut and removed from its position. A vertical tubular gastrectomy was performed using an upper endoscope as a calibrator with multiple loads of the Endo-GIA stapler with staple-line reinforcement. Haemostasis was checked and an air leak test performed. The operative time was 220 minutes and estimated blood less than 20 cc. There was no intraoperative complication and an upper GI showed good passage of the contrast without leak with discharge of the patient on post operative day 2.
The conversion of gastric band to sleeve gastrectomy is a valid therapeutic option for patients with no substantial weight loss although long term follow up is required. The robotic technology is a useful option in redo surgery, allowing for accurate, precise, fine dissection, with the 4th arm assisting in retraction of the fundus which is usually distorted after band placement.


Session Number: VidTV1 – Video Channel Rotation Day 1
Program Number: V092

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