Michael J Lee, MD, Daniel J Scott, MD FACS. UT Southwestern Medical Center
INTRODUCTION: This video describes a laparoscopic approach to sleeve gastrectomy as a revisional procedure for failed vertical banded gastroplasty.
METHOD: The patient was a 52 year old woman with a prior vertical banded gastroplasty and a BMI of 57. Her history is complicated by an incisional hernia for which she under went a mesh repair. She presents four years later with chronic complaints of nausea, heartburn, and dysphagia. Her workup revealed that she had a moderate sized hiatal hernia. She underwent laparoscopic exploration for a possible hiatal hernia repair. The patient was placed in a split let position in spreader bars. A 12mm trocar was placed in the left subcostal location. A 12/15mm trocar was placed 15cm inferior to the xiphoid process. A 5mm trocar was placed in the right and left subcostal locations, and also in the left lower quadrant. A Nathanson liver retractor was placed through a midepigastric 5mm incision. Her perigastric fat was retracted using sutures attached to the abdominal wall. Her prior vertical staple line, Marlex gastric band, and super obesity compromised a potential fundoplication. In addition, her dense lower abdominal adhesions did not make a roux-en-y gastric bypass feasible. Sleeve gastrectomy was then performed using linear cutting staplers guided by an endoscope.
RESULTS: Postoperatively after the patient’s edema subsided, her symptoms resolved and her BMI decreased from 57 to 50.
Conclusions: Laparoscopic sleeve gastrectomy is both a feasible and effective revisional procedure for prior vertical banded gastroplasty.
Program Number: V022