Revisional Bariatric Surgery: From Sleeve Gastrectomy to Robotic-Assisted Gastric Bypass

M Masrur, MD, F Gheza, MD, D Calatayud, MD PhD, S D’ugo, MD, F M Bianco, MD, E F Elli, MD FACS. Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA.

Introduction
The laparoscopic sleeve gastrectomy (LSG) is used as an effective procedure for morbid obese patients. There are long term complications associated to this procedure; one of these is the Gastroesophageal reflux (GERD), many times difficult to treat. We present here a video using the laparoscopic approach in a patient with LSG and severe GERD, and the resolution through conversion to Roux-en-Y gastric bypass (RYGBP).
Methods
A 59-year old obese woman, BMI 48, who underwent a LSG 20 months ago develops severe GERD with severe esophagitis. Due to the lack of medical control is elected for conversion to RYGBP.
Results
The procedure began with a diagnostic laparoscopy. After the Docking of the Robot, dissection was carried out on the scar tissue around the VSG using robotic monopolar hook. Dissection and repair of an small hiatal hernia was done. A Gastric pouch was created using staplers. Then the jejunum-jejunum anastomosis was done with stapler and hand sewn suture; and the mesenteric gap was closed with hand sewn suture. The gastro-jejunal anastomosis was created by double layer hand sewn suture using polydioxanone 3.0. An endoscopic evaluation of the stomach and air leak test was performed, confirming integrity of the gastro-jejunal anastomosis. The operative time was 260 minutes. There were no intra- or post-operative complications. Patient was discharged on postoperative day 3.
Conclusions
The GERD after a LSG is a complication many times difficult to treat. The conversion to RYGBP is a valid therapeutic option in these patients. Although more information on the long term follow up is necessary to draw definitive conclusions.