Anne P Ehlers, MD, MPH, Saurabh Khandelwal, MD, Andrew S Wright, MD, Judy Y Chen-Meekin, MD. University of Washington
The patient is a 37-year-old woman who had previously undergone an open sleeve gastrectomy at another institution. Several years after her initial operation, she had a BMI of 40 and was experiencing symptoms of heartburn and reflux. Pre-operative EGD showed esophagitis and upper GI showed a small hiatal hernia as well as an enlarged fundus. Given her symptoms as well as her BMI of 40, we recommended revision of her bypass to Roux-en-Y gastric bypass. We performed intraoperative endoscopy and located a significant amount of redundant fundus that was likely contributing to her symptoms. To address this, we resected the excessive fundus to construct a more optimally sized pouch. From this case we learned that inadequate mobilization of the stomach can lead to a failure to recognized the amount of redundant fundus resulting in a staple line far away from the GE junction and angle of His. This was a likely contributor to the patient’s esophagitis and reflux. Data from the ASMBS indicates the increased incidence of sleeve gastrectomy. In 2011, approximately 18% of all bariatric surgeries were sleeves, compared to nearly 60% in 2017. At the same time, revisional surgery has increased as well, from 6% in 2011 to 24% in 2017. Given the popularity of this procedure as well as the increase in revisions, it is imperative that surgeons performing this operation understand the importance of an adequate dissection.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95647
Program Number: V397
Presentation Session: Video Loop Day 4
Presentation Type: VideoLoop