Jeffrey E Quigley, DO, Manuel Garcia, MD, Esther Wu, MD, Stephanie Keeth, DNP, Aarthy Kannappan, MD, Daniel Srikureja, MD, Keith R Scharf, DO, FACS, FASMBS, Marcos Michelotti, MD, FACS. Loma Linda University Health
We present the case of a 49-year-old female who is status post sleeve gastrectomy presenting 2 years ago, now presented with de novo refractory GERD, weight regain, and loss of feeling food restriction. Conversion to Roux-en-Y gastric bypass addresses both problems in patients which have combined intractable GERD and weight regain. However, the patient declined conversion to gastric bypass. Here we describe an alternative approach that may be useful in a patient who refuses conversion to gastric bypass after medical management has failed. The pre-operative workup included an EGD which showed laxity of the lower esophageal sphincter and a dilated sleeve with significant excess fundus. After multidisciplinary assessment was completed, surgical options were discussed with the patient. The decision was made for robotic assisted sleeve gastrectomy revision. Using excess fundus, we performed a Toupet fundoplication for treatment of GERD, along with suture gastric plication to address weight regain. The patient did well and was discharged home the following day. At most recent follow-up she had complete resolution of GERD and 29% excess weight loss. Sleeve gastrectomy is one of the most commonly performed bariatric procedures worldwide and it has achieved proven long terms results. However, weight regain and de novo GERD are possible outcomes. Revisional surgery is indicated in cases of refractory GERD and weight regain that are refractory to medical management.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87961
Program Number: V091
Presentation Session: Thursday Exhibit Hall Theater (Non CME)
Presentation Type: EHVideo