Laparoscopic Conversion of Sleeve Gastrectomy to Roux-En-Y Gastric Bypass As a Treatment Option for Chronic Staple Disruption After Sleeve Gastrectomy

A Bernsteyn, M Gianos, A Abdemur, S Szomstein, R J Rosenthal. Cleveland Clinic Florida

Introduction: This video illustrates the use of laparoscopic techniques in the management of a sleeve gastrectomy complicated with a gastroperitoneal fistulous tract, with a conversion to a Roux-en-Y gastric bypass (RYGB) as final treatment.

Discussion: The patient is a 43 year old male who presented with erosion of a gastric band. The band was removed and converted to a sleeve gastrectomy. After the sleeve gastrectomy the patient presented with leakage from a staple line disruption, which was managed with a CT guided percutaneous drainage and endoscopic stent placement. In consultation, the patient complains of back and shoulder pain. A CT scan of the abdomen shows a left upper quadrant collection. The patient underwent a laparoscopic revision with conversion to a RYGB. Two days after the revision an upper GI showed an unremarkable thoracic esophagus and an intact gastrojejunostomy. There was no evidence of leak or obstruction. On postoperative day two the patient was started on liquids and was discharged home on postoperative day four.

Conclusion: Laparoscopic conversion of LSG to a RYGB for chronic staple line disruption appears to be safe and feasible treatment option.