Julie A Stortz, MD, Russell B Hawkins, MD, Alexander L Ayzengart, MD, MPH, Jeffrey E Friedman, MD. University of Florida
Background: Revisional bariatric surgery has become increasingly prevalent due to the rising number of bariatric procedures to treat morbid obesity. Here we describe a case in which a patient required reoperation following Roux-en-Y gastric bypass (RYGB) for weight regain and mesh erosion.
Methods: A 52 year old female with morbid obesity (BMI 58.5) underwent open RYGB in 1998 with mesh placement around her gastrojejunostomy. She presented to our clinic with weight regain (BMI 48.2) and symptoms of nausea/reflux. EGD revealed eroded mesh into the gastrojejunostomy. Therefore, we planned for laparoscopic revision of her gastric pouch and gastrojejunostomy with mesh explantation. To accomplish this, extensive adhesiolysis was performed until the remnant stomach, gastric pouch, and Roux limb were freed from surrounding structures. The mesh was then extracted from an enterotomy in the Roux limb just distal to the gastrojejunostomy. After identifying the left gastric artery, the gastric pouch and Roux limb were divided with a stapler to resect the gastrojejunostomy and distal enterotomy. Additional enterotomies were then made in the stapled gastric pouch and Roux limb and a linear stapled gastrojejunostomy was created. The common enterotomy was closed with a running suture. Intraoperative EGD with pneumatic interrogation of the reconstructed gastrojejunostomy revealed no evidence of leak.
Results: Postoperatively, a diet was initiated after CT esophagram demonstrated no leak. 1-month follow up revealed a 28lb weight loss.
Conclusions: Laparoscopic partial gastrectomy with Roux-en-Y reconstruction is a reasonable management option for bariatric patients requiring revisional surgery in the setting of mesh erosion.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92023
Program Number: V059
Presentation Session: Exhibit Hall Theater Video Session II
Presentation Type: EHVideo