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REVISIONAL GASTRIC BYPASS

Ricardo Nascimento, MD, Darlan M Kestering Medeiros, MD, Jaime Cesar M Gelosa Souza, MD, Luiz Henrique M Locks Corrêa, MD, Matheus M Pacheco Dos Reis, MD. HNSC

It is now generally accepted that bariatric surgery is the most effective therapy for morbid obesity. During the last decade, there has been an accelerated growth in the number of bariatric procedures performed annually, with about 220,000 performed in the USA in 2009, according to the American Society for Metabolic and Bariatric Surgery. With this increasing demand for bariatric surgery, there are a growing number of patients who require revisional surgery due to the undesirable results of their primary bariatric procedures. Unsuccessful weight loss and anatomic complications are the two most common reasons for pursuing revisional surgery. Marginal ulcer is not infrequent after laparoscopic Roux-en-Y gastric bypass and could result in undesirable complications, such as intractability, bleeding, or perforation. Those patients who failed medical therapy, regarded as refractory marginal ulcers, may be considered as candidates for revisional surgery. Herein, we make a video presentation of a laparoscopic revisional procedure for refractory marginal ulcer. There are growing numbers of patients who require revisional bariatric surgery due to the undesirable results of their primary procedures. The overall incidence of surgical revision after a primary bariatric procedure varies widely in the published literature and has been reported to be in the range from 5 to 56 %. The choice of revisional procedure is dependent on the primary bariatric procedures and the indications for revision. Recent advances in laparoscopic techniques and instrumentation enable bariatric surgeons to perform laparoscopic revisional surgery. Although there are limited data available, it has been reported that the morbidity and mortality related to open or laparoscopic revisional surgery are acceptably low and that the beneficial outcomes overweigh the risk This video is about a male paciente 34 years old. He was submitted a gastric bypass in 2012 in Boston, Massachusetts. In 2014 he was submitted a cholecystectomy, he had a cronic epigastric pain all time after the gastric bypass. The endoscopic show a marginal ulcer not responsive a clinical treatment an a large pouch with a residual fundus. At this moment the revisional surgery was indicated. Revisional bariatric surgery effectively treated the undesirable results from primary bariatric surgery. Laparoscopic revisional surgery can be performed after both failed open and laparoscopic bariatric procedures without a prohibitive complication rate. Carefully selected patients undergoing revision for weight regain have satisfactory additional weight loss.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 93518

Program Number: V144

Presentation Session: Revisional Bariatrics/Foregut Video Session

Presentation Type: Video

64

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