Crystal Alvarez, DO, Maher Musleh, MD, FACS, Juan Carlos Quispe, MD, Esther Wu, MD, Panicha Kittipha, MSN, RN, Daniel Srikureja, MD, Jeffrey Quigley, DO, Marcos Michelotti, MD, FACS, Keith Scharf, DO, FACS, FASMBS, Aarthy Kannappan, MD. Loma Linda University Medical Center
Our patient is a 50 year old female with a complicated bariatric surgery history who presented to our clinic with persistent GERD symptoms. She had undergone placement of a lap band in 2002 resulting in 100 pound weight loss. A few years later the band slipped and was revised. In 2010, it slipped a second time and was removed. She gained 160 pounds thereafter and subsequently underwent a lap sleeve gastrectomy in 2012. At this time she began to have GERD symptoms. Imaging showed a hiatal hernia, and she was taken to the OR in 2014 for a robotic hiatal hernia repair with mesh. During this operation, excess fundus was noted, and it was used as a Dor fundoplication. She had improvement in GERD symptoms for a few months, but they shortly returned. A few years later she returned for followup and further workup. She was found to have a normal DeMeester score on pH probe testing and EGD showed no evidence of a recurrent hiatal hernia. However, the Dor did not appear to be intact. She continued to have classic GERD symptoms that were affecting her quality of life. She was therefore offered revisional bariatric surgery with conversion to a gastric bypass. The video presented demonstrates the difficult anatomy associated with multiple foregut procedures. Postoperatively, the patient developed a mild gastrojejunal anastomotic stricture around six weeks. This was balloon dilated and she did well afterwards. At her 3 month visit, she was tolerating a regular bariatric diet, lost approximately twenty pounds, and endorsed complete resolution of her GERD symptoms.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93556
Program Number: V229
Presentation Session: Video Loop Day 2
Presentation Type: VideoLoop