Introduction: Laprascopic gastric bypass is a very common procedure performed in many university and community hospitals throughout the United States. Some of these patients present with later complications related to remnant stomach.Commonly these include gastritis,ulcers or bleeding.Evaluating the remnant stomach is always a challenge to the surgeon. We performed a combined Laprascopic and endoscopic technique and successfully evaluated the gastric remnant and placed a gastric feeding tube in the gastric remnant . Procedure was done successfully with minimum morbidity and short operative time.
Methods: 60 yr old male with history of gastric bypass 2 years ago presented multiple times to the hospital with chronic anemia and positive guiac positive stools.Upper and lower endoscopes were performed multiple times and radiological tests including CT scan was done without any conclusive results.After being refused by Interventional radiologist to perform gastrostomy because of anatomical reasons ,we decided to perform exploratory laprascopy and evaluation of gastric remnant with placement of gastrostomy tube.We successfully placed the laprascopic gastrostomy in the remnant stomach and also evaluated the whole remnant stomach endoscopically upto third part of duodenum and laprascopic and endoscopic images were obtained.Standard flexible endoscope was introduced through the 15mm abdominal port in a sterile manner and guided with laprascopic assistance for evaluation.The whole procedure was performed in a minimal time and without any morbidity.Intracorporeal sutures were placed between the remant stomach and abdominal wall.
Result : We successfully evaluated the gastric remnant with combined laprascopic and endoscopic technique in a minimal time. A simple 18 french gastrostomy tube was placed and intracorporeal sutures were placed to secure the gastric remnant with anterior abdominal wall in a circumferential manner.
Conclusion: Evaluating the gastric remnant after the gastric bypass has always been a challenge. But combined endoscopic and laprascopic exploration can be performed using basic laprascopic and endoscopic instrumentation without any additional morbidity and in a minimal time.
Program Number: P079