Anna E Martin1, Dimitrios Stefanidis, MD, PhD2. 1Indiana University-Purdue University Indianapolis, 2Indiana University School of Medicine
Gastric bypass reversal is an effective rescue procedure for reactive hypoglycemia after a gastric bypass operation.
In this video, we present a Robotic Gastric Bypass Reversal with Sleeve Gastrectomy on a 45-year-old female who had undergone a gastric bypass in 2003 for morbid obesity. Over the past 9 months before her reversal, she had been suffering from severe reactive hypoglycemia. Medical treatment by endocrinology did not address her symptoms despite different attempted strategies with several episodes of hypoglycemia and related falls during the day. She was offered bypass reversal with sleeve gastrectomy to help her symptoms and maintain weight loss benefits.
For her operation, 4 robotic arms and an additional 12 mm laparoscopic port were used. Lysis of adhesions was extensive and took greater than 50% of the duration of this procedure. The gastric pouch was divided proximal to the prior GJ while the Roux was divided proximal to the J-J as it was fairly short (appr 30 cm). The Roux was then removed. The divided pouch was anastomosed to the gastric remnant using a handsewn technique. The remnant fundus was resected, and the rest of the gastric remnant was sleeved using the endoscope as the bougie. A leak test using EGD was negative.
The procedure was very demanding technically and lasted 6.5 hours but was accomplished safely. There were no intraoperative complications, and the patient was discharged home on POD #2. On 3 months follow up, the hypoglycemic episodes had completely resolved, and the patient had not regained weight. Enhanced 3D visualization, platform stability, and improved precision make the use of robotic surgery for complex foregut procedures appealing.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95766
Program Number: V345
Presentation Session: Video Loop Day 3
Presentation Type: VideoLoop