Robot-Assisted conversion from Nissen fundoplication to Gastric bypass

Background:
A 35 years old morbidly obese woman presented with a BMI 41 kg/m2. Her previous surgical history was significant for cholecystectomy and open Nissen fundoplication. A decision was made to take down the Nissen and perform a gastric bypass.
Material and methods:
Six 12 mm trocars were used (supra-umbilical position, left iliac quadrant, xyphoid, left and right mid-clavicular line and left anterior axillary line). The procedure was performed with the assistance of the Da Vinci S Robot. Thanks to its 3D view, it eased the adhesiolisis and the take-down of the previous Nissen fundoplication. After complete freeing of the hiatus and the oesophagus, a gastric bypass was carried out. A jejuno-anastomosis was performed with a 75 cm biliary limb of a 150 cm alimentary limb. The dissection of the upper part of the stomach allowed the stapling of a small gastric pouch and a gastro-jejuno anastomosis was performed using a 25 mm circular stapler (Covidien). The tightness of the suture was controlled by an intraoperative methylene blue test.
Results:
The post-operative course was uneventful. At 7 months follow-up, the patient had a BMI of 29 with a 32 kg weight loss.
Conclusion:
Robotic assistance was helpful in performing the adhesiolisis and the take-down of the previous fundoplication thanks to the 3D view of the anatomical landmarks and the 7 degrees of freedom of the robotic instruments.


Session: Podium Presentation

Program Number: V020

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