Revision of Roux-En-Y Gastric Bypass to Sleeve Gastrectomy and Hiatal Hernia Repair

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

Advanced Lapascopic Surgery Associates, UCSF Fresno

In this video, we present the conversion of a Roux-en-Y gastric bypass to a sleeve gastrectomy. The patient is a 39 year-old woman who initially underwent laparoscopic Roux-en-Y gastric bypass in 2001. A revision was then performed in 2003 for suboptimal weight loss, where the gastric pouch was revised and a Silastic band was placed to the distal gastric pouch. She then underwent revision to a distal gastric bypass. She developed symptoms of reflux and also had weight recividism. Endoscopy demonstrated stenosis of the distal gastric pouch at the location of the Silastic band. She was taken to the operationg room for conversion sleeve gastrectomy, removal of the Silastic band, and hiatal hernia repair. After entry into the abdomen, attention was first turned to the intestinal anastomosis, which was taken down with primary suture closure of the resulting enterotomy. The retrocolic Roux limb was then dissected just inferior to the transverse mesocolon and divided. Attachments of the proximal Roux limb to the transverse colon mesentery were divided, allowing the Roux limb to be brought superiorly. The jejunal anastomosis was performed using a single layer of absorbable suture. The Silastic band was removed. The Roux limb was dissected from its mesentery and from the gastric pouch. The hiatus was dissected, revealing a hiatal hernia, which was repaired. The short gastric vessels and other attachments were divided so as to free the remnant stomach. A gastrotomy was made in the remnant stomach, and the anastomosis was performed using interrupted Vicryl suture. The gastric sleeve was fashioned using a laparoscopic linear stapler, and the gastrogastrostomy was completed. Endoscopy was performed to visualize the anastomosis and also to perform an air leak test. A drain was left in place alongside the gastrogastrostomy. The patient was started on a clear liquid diet on postoperative day 3 and discharged on postoperative day 4.

Session: Video ChannelDay 3

Program Number: V119