Seromyotomy as a Treatment Option After Laparoscopic Sleeve Gastrectomy

Abraham Betancourt, MD, Armando Rosales-Velderrain, MD, Fernando Dip, MD, Charles Thompson III, MD, Emanuele Lo Menzo, MD, PhD, Samuel Szomstein, MD, FACS, Raul Rosenthal, MD, FACS. Cleveland Clinic Florida.

Introduction: Currently, laparoscopic sleeve gastrectomy and roux-en-y gastric bypass are the two most common procedures. Both of these have known rates of complications. Though the management of these has to be tailored to each patient situation.

Methods: Our patient is a 44 year-old male with a body mass index of 38.9 kg/m2 who recently underwent a laparoscopic sleeve gastrectomy and presented on postoperative day 20 with gastric outlet obstruction. The abdominal computed tomography scan revealed a partial thrombus within the main portal vein and stranding of the peripancreatic fat in the head of the pancreas. Upper barium swallow demonstrated a stenosis at the esophagogastric junction or proximal sleeve.

Results: In this video we demonstrated both the surgeries performed to treat this complication. Initially, he underwent a laparoscopic reduction of a hiatal hernia, takedown of both the imbricating sutures of the sleeve and adhesive band in the proximal stomach. After this procedure, symptoms did not resolved and during the same hospitalization the patient underwent a laparoscopic gastric seromyotomy. At two-week surgical follow-up his obstructive symptoms had resolved, blood sugar levels and insulin required were less.

Conclusion: Laparoscopic gastric seromyotomy can used as an alternative procedure to resolve obstructive symptoms after sleeve gastrectomy.

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