Enrique F Elli, MD, FACS, Myrian Vinan-Vega, MD, Tamara Diaz Vico, MD. Mayo Clinic Florida
A 67 years-old female (BMI = 36 kg/m2), with history of laparoscopic Nissen fundoplication, presented with epigastric pain and regurgitation. Preoperative studies were performed. Upper GI showed a recurrence of the hiatal hernia and a slipped Nissen, which was confirmed by the endoscopy.
Patient was selected to undergo a robotic conversion into a Roux-en-Y gastric bypass.
The procedure started with the dissection of the hiatus. There were dense adhesions between the liver, the stomach, and the previous wrap. Using robotic scissors, all these adhesions were carefully removed. Some of the short gastric vessels were divided and, from the left side, the mediastinum was accessed. A bougie was then passed to identified the esophagus and have a clear anatomy. The fundoplication was dissected from the esophagus and, after dissecting the right crus, the mediastinum was accessed through this side too in order to bring the gastroesophageal junction back to the abdomen. A retroesophageal window was created and a Penrose drain was passed around in order to facilitate the dissection.
Once the hiatus was completed dissected, the hiatal hernia was repaired with interrupted 0-Ethibond sutures. Three sutures were needed to complete the hiatal hernia repair. A retrogastric window was created 5cm below the gastroesophageal junction in order to construct the gastric pouch with an endoGIA purple load. The jejuno-jejunostomy was performed using a side-to-side mechanic anastomosis. The enterotomy was closed with 3-0 PDS suture in a running fashion. The alimentary limb was added up using an antecolic technique, and the gastro-jejunostomy was constructed with running 3-0 PDS sutures.
The operative room time was 4 hours. The postoperative upper GI showed no evidence of leaks. The patient was asymptomatic and she was discharged in the postoperative day 3. No recurrence of the hiatal hernia was evidenced.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94602
Program Number: V199
Presentation Session: Video Loop Day 1
Presentation Type: VideoLoop