Incidental Finding of Ligated Left Gastric Pedicle During Revision of VBG to Bypass

Michael J Mulcahy, MD, James P Villamere, MD, Matthew Kroh, MD, John Rodriguez, MD. Cleveland Clinic Foundation

This case is a 62 yo female who underwent VBG in the 1980s and subsequently underwent laparoscopic adjustable gastric banding in 2007.  In 2014 she underwent laparoscopic converted to open removal of gastric band for chronic nausea.  She presented to our institution with chronic nausea, maladaptive eating and epigastric discomfort.  Esophageal motility and gastric emptying studies were normal and UGI showed VBG stricture and epiphrenic diverticulum.  She elected to proceed with revision of VBG to Roux-En-Y bypass during which the left gastric pedicle was found to have been ligated during a prior operation.  This required formation of esophago-jejunostomy with resection of epiphrenic diverticulum and passage of endoscopic snare to secure a wire which was used to pull the Orvil into place.  We present our technique for adapting to intraoperative difficulties.

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