Robot-Assisted revision of Gastro-Jejunal anastomosis after RYGB

Subhashini Ayloo, MD, Young Roh, MD, Mario A Masrur, MD, Pier C Giulianotti, MD, FACS

University of Illinois at Chicago

Introduction: Anastomotic ulcer at the gastrojejunostomy site after Roux-En-Y gastric bypass operation is a known complication that may usually be associated with a fistula between gastric remnant and gastric pouch of the anastomosis. Surgical management with revision of gastro-jejunal anastomosis is the treatment of choice if they are refractory to medical treatment. Revisional surgery can be challenging, especially with laparoscopy and using the robot may offer some advantages.

Methods: A prospective review of two patients who underwent revision of Gastro-Jejunostomy for confirmed anastomotic ulcers after Roux-en-Y gastric bypass for morbid obesity, that are refractory to medical management, was performed in year 2012. Data was collected on patient factors, intra-operative findings and post-operative outcomes.

Results: Both patients had confirmed anastomotic ulcers on endoscopy with persistent symptoms that are refractory to medical treatment. Both patients are female with mean age of 42 yrs and BMI of 28 Kg/m2. On exploration, both patients found to have extensive adhesions and a fistula between gastric remnant and gastric pouch. In both cases the previous anastomosis along with fistula was resected and revision of gastro-jejunostomy was performed. Both procedures were performed successfully in minimally invasive approach using the robot. Mean operative time is 234 mins (195 and 280 mins) and mean estimated blood loss is 25 ml. Both patients had upper GI series post-operatively and were fed after ruling out anastomotic leak. These patients had uneventful post-operative course and were discharged with mean hospital stay of 4 days. On follow-up, both patients had resolution of their previous symptoms related to the anastomotic ulcers.

Conclusions: The use of robot in the revision of gastro-jejunal anastomosis after gastric bypass is feasible and safe with good clinical outcomes.

Session: Video ChannelDay 2

Program Number: V073

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