Revision of Gastrojejunostomy for Stenosis

Ruby Gatschet, MD, Cyrus Moon, MD, Saber Ghiassi, MD, MPH, Keith Boone, MD, Kelvin Higa, MD

Advanced Laparoscopic Surgery Associates, UCSF Fresno

In this video, we present the revision of a gastrojejunostomy for stenosis. The patient is a 52 year-old woman who initially had Roux-en-Y gastric bypass in 1999. In 2001, she underwent repair of a perforated marginal ulcer, followed by revision gastroplasty for a chronic non-healing ulcer in 2003. She was then converted to a gastric sleeve in 2009 in light of the development of gastrointestinal dysmotility symptoms; her postoperative course was complicated by leak, which was treated with stenting. Her dysmotility symptoms did not improve and she developed weight recidivism. Therefore, she was converted back to a gastric bypass in 2011. She then presented with a persistent gastrojejunal stenosis that was nonresponsive to multiple attempts at endoscopic dilation. She was taken to the operating room for revision of her gastrojejunal stenosis. Upon entry into the abdomen, numerous adhesions were noted, which were lysed. As the adhesiolysis proceeded superiorly, the Roux limb was noted. Intraoperative endoscopy demonstrated a very tight stenosis and an enlarged gastric pouch. Further dissection revealed that the gastrojejunal anastomosis was located eccentrically on the gastric pouch, away from the lesser curve. After the Roux limb was transected, allowing for a line of demarcation to appear along the anastomosis, the proximal Roux limb was dissected off of the gastric pouch. The previous vertical staple line was also resected, and the gastric pouch was reformed using the linear cutting stapler. An enterotomy was then made in the Roux limb, and the anastomosis was completed using full-thickness interrupted suture. Endoscopy confirmed a smaller pouch and a patent anastomosis. A drain was left in place along the anastomosis. The patient was started on clear liquids immediately after surgery and discharged on postoperative day 3. Her symptoms of dyphagia have improved.

Session: Podium Presentation

Program Number: V009

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