Case Report of Revisional Bariatric Surgery: Sleeve Gasrectomy to Gastric Bypass

Adrian Marius Nedelcu, Jean Michel Fabre, Professor, David Nocca, Professor. CHU Montpellier

We present a case of revisional bariatric surgery. It is a conversion of sleeve gastrectomy into a gastric bypass. The patient is a 53 y.o. male with a BMI of 59. As past medical history we mention an episode of pulmonary embolism after sleeve gastrectomy as well as UTI. For surgical we notice a gastric banding in 1999 which was removed in 2006 for inefficacity. In 2008 we had a sleeve gastrectomy complicated with a fistula. As you mentioned already the procedure starts with an extensive lysis of adherences, expected from his surgical history. After reaching the upper part of the abdomen we started to free the gastric tube from the liver. After clarifying the local anatomy we start to dissect the lateral and posterior part of gastric tube. We came back to dissect the lesser curvature and we star to divide/transect/section the gastric tube. We realized that with the help of 3 green cartridge. We consider the previous gastric and also the gastric pouch is too large we decide it to diminish it. We dissect the posterior part of the gastric ouch and we divide/section it. We remove the excess of gastric pouch in a bag. We count 150 cm for biliary limb and we section the small bowel. We divide also the great omentum to decrease the tension on the alimentary limb. We start the anastomosis by incising the posterior part of the gastric pouch. After opening also the small bowel we realize the anastomosis with a yellow cartridge. We close the anastomosis by calibrating with a 36 French tube. We count 200 cm for alimentary limb and we realize the entero-entero anastomosis between the afferent and biliary limb. We place a drain tube. The radiological control at day was normal and the patient was discharged 5 days postoperatively.