Lisa Renee Hilton, MD, Geoffrey Nadzam, MD, FACS, FASMBS, Matthew Hubbard, MD, Saber Ghiassi, MD, FACS, FASMBS, Kurt Roberts, MD, FACS, FASMBS, Andrew J Duffy, MD, FACS, FASMBS. Yale University
The patient is a 49 year old female who presented to the emergency department with forty eight hours of abdominal pain, nausea, vomiting, and leukocytosis. She had been experiecing similar pain for over two months, but in the past two days the pain became significantly worse. She had a past surgical history of vertical banded gastroplasty and multiple ventral hernia repairs with mesh. CT scan of the abdomen revealed mesh erosion from the posterior wall of the stomach with perforation into the lessor sac. Upper endoscopy confirmed eroded mesh through the posterior wall of the stomach. She is a current smoker, has demonstrated poor compliance, and was malnourished with an admission albumin of three. Diagnostic laparoscopy was performed with the intention of performing a roux-en-y gastric bypass reconstruction; however, due to numerous adhesions throughout her lower abdomen from the previous ventral hernia repairs as well as her malnutrition and smoking, a decision was made introperatively to perform a gastrogastric anastamosis. During the operation an abscess cavity was encountered in the lesser sac, and the mesh from her previous vertical banded gastroplasty had eroded into the body of the pancreas. A wedge gastrectomy of the previously banded gastroplasty along with the eroded mesh were all removed en bloc. The greater curvature of the stomach was then anastamosed to her proximal gastric pouch. Her final reconstructed anatomy is more consistent with a gastric sleeve than a roux-en-y gastric bypass. She did very well post-operatively. Her diet was progressed back to bariatric maintenance, and she has had no complications from the procedure. We will continue following her post-operatively and monitoring her nutrition and progress.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79446
Program Number: V175
Presentation Session: Video Loop
Presentation Type: VideoLoop
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