Laparoscopic Conversion of Gastric Band to Laparoscopic Gastric Bypass Due to Failure of Weight Loss and Worsening Gastroesophageal Reflux

Guillermo Higa, MD, Abraham Abdemur, MD, Samuel Szomstein, MD, Raul Rosenthal, MD. Cleveland Clinic Florida

Introduction:
One of the most difficult and challenging problems in bariatric surgery is working with a patient who has failed to achieve control of comorbidities or weight through a primary bariatric procedure. There are a number of patients who experience complications or failure of weight loss after gastric band procedure.

Methods and Procedures:
We present a case of a 48-year-old female who underwent a conversion of gastric band to laparoscopic Roux-en-Y gastric bypass due to failure of weight loss and worsening gastroesophageal reflux secondary to a hiatal hernia. Once the port is removed, we proceed to dissect the band capsule using sharp dissection. The hiatal crus is closed with a figure-of-eight of QuillTM suture. Using an Ewald tube as guidance, the stomach is vertically transected, creating a gastric pouch which is approximately 30 cc in diameter. The ligament of Treitz is identified and 50 cm from it, and the small bowel is transected. The distal limb of the small bowel is brought to the upper abdomen in an antecolic- antegastric fashion. A side-to-side gastrojejunostomy between the pouch and alimentary limb is performed. The posterior wall is created with a linear stapler and the anterior wall is closed with a double layer of running 2-0 Vicryl sutures. The anastomosis is checked for leaks with air and methylene blue. 100 cm from the gastrojejunostomy, a side-to-side jejunojejunostomy between the biliopancreatic and alimentary limbs is created with two applications of a linear stapler before the jejunojejunostomy is closed.

CONCLUSIONS:
Laparoscopic conversion from LAP-BAND to RYGBP is safe and can be an alternative for patients who failed weight loss after undergoing a LAP-BAND procedure. Revisional surgery represents a technical challenge and should be performed only by surgeons who have completed the learning curve for laparoscopic RYGBP.

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