Laparoscopic Revision of Gastric Banding to Roux-en-Y Gastric Bypass: Technical Pearls.

Laparoscopic Adjustable Gastric Banding (LAGB) is the most commonly performed procedure in Europe and Australia for weight loss. However, with a failure rate approaching 40% at 5 years there is an increasing number of revisional surgeries being performed. Revisional surgeries are technically demanding and are associated with an increased rate of complications. Mulitple recent reports have demonstrated the safety of laparoscopic Roux-en-Y-gastric Bypass (RYGB) in patients who failed LAGB when performed by experienced surgeons. We report the case of a 58 year old woman with a BMI of 41 who failed to loose any weight 1 year after LAGB. The patient underwent laparoscopic removal of gastric band and RYGB in a single setting. The Patient was discharged two days after the operation. The indication for revision in our patient was lack of weight loss. Our video shows multiple key steps of the procedure that should be performed in a sequential manner for a successful outcome. In this video, the previously placed gastric band was initially removed followed by the performance of the RYGB. First, the pseudocapsule around the band was unroofed using electrocautery. Second, the stomach imbrication was taken down using sharp dissection and a harmonic scalpel. The angle of His was then dissected. Instead of our standard perigastric dissection at the time of pouch creation, the gastrohepatic ligament was transected using a vascular stapler followed by the creation of a small gastric pouch using a stapling device.Finally, the angle of His was dissected off the left crus in a meticulous fashion using a combination of blunt dissection and energy source using the harmonic scalpel. Laparoscopic revision of gastric banding into RYGB is feasible and safe with only few changes to the routine steps of a laparoscopic RYGB.

Session: Video Channel

Program Number: V048

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