S. Julie-Ann Lloyd, MD, PhD, Katherine Meister, MD, Philip Schauer, MD. Bariatric and Metabolic Institute, Cleveland Clinic
Introduction: Morbid obesity remains a grave public health epidemic with a predicted global prevalence of 50% by 2030. Gastric bypass is one of many surgical options to treat the disease but can be rife with complications, such as leak, obstruction and fistula, and may result in recidivism. This case report highlights the technical challenges with managing such complications.
Methods: A 49-year-old female with remote history of gastric bypass presented to our clinic with a presumed gastro-jejunal fistula and weight regain. Revision surgery was performed. Dissection was initially aimed at the separation of the gastric pouch, remnant and the Roux limb. Intra-operative findings were consistent with the presence of a gastro-gastric fistula, which was resected prior to reconstruction of a double-layer, hand-sewn gastro-jejunal anastomosis. Finally, the Seldinger technique was applied to create a remnant gastrostomy.
Results: Post-operatively, the patient developed a contained leak that could be managed non-operatively and nutrition was provided via the remnant gastrostomy tube. She awaits follow-up imaging studies as an outpatient.
Conclusion: Revision bariatric surgery requires a comprehensive intraoperative approach, including the use of endoscopy, to evaluate the anastomosis and aid in the early diagnosis of potential complications. Additionally, drain placement may convert a leak into a controlled fistula and obviate the need for additional surgical interventions.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79744
Program Number: V054
Presentation Session: Thursday Exhibit Hall Video Presentations Session 3 (Non CME)
Presentation Type: EHVideo