Romina Pena, MD, Ainitze Ibarzábal, MD, Dulce Momblán, MD, Víctor Turrado, MD, Josep Llach, MD, PhD, Antonio M Lacy, MD, PhD, FASCRS, Hon. Hospital Clínic
32-year old woman with history an open RYGB in 2006, complicated with anastomotic leak and stenosis. Patient had an initial and minimum weight of 170 Kg (BMI 60) and 73 Kg (BMI 26) respectively. In 2016, presented with abdominal pain, vomiting and weight regain up to 109 Kg (BMI 39) and was referred to our center. Upper GI series and contrasted CT both confirmed the presence of a GGF. Endoscopy showed an included gastric band. Given the complexity of the case, revisional surgery with a multidisciplinary approach was proposed. Exploratory laparoscopy revealed severe adhesions due to prior surgery. A GGF was identified between the craneal part of the pouch and the remnant. Under direct laparoscopic and endoscopic view, the included band was spotted at the proximal part of the pouch and retrieved with a snare with no complications. Simple fistula excision was performed with a linear stapler. Correct vascularization of the pouch and remnant was assessed with (ICG). Staple lines were reinforced and the procedure was concluded with no intraoperative complications. Postoperative period was uneventful. After a 5-month follow-up, patient remains asymptomatic. A multidisciplinary intraoperative approach like the one completed in this video, especially in complex cases, allows for a complete anatomical evaluation and safe performance of the revisional procedure.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95285
Program Number: V054
Presentation Session: Bariatric II – Revisions
Presentation Type: Video
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