Jingjing L Sherman, MD, David M Brams, MD, FACS, Dmitry Nepomnayshy, MD, FACS. Lahey Medical Center
Gastric bypass is the gold standard for obesity and its related comorbid conditions. However, 20% of patients fail gastric bypass. Failure is defined as excess weight loss less than 50% or BMI greater than 35. For patients who fail gastric bypass, there are many options, but the one with the best outcome is conversion to biliopancreatic diversion with duodenal switch (BPD-DS).
We present a case of a patient who regained weight after gastric bypass, and had a laparoscopic conversion to BPD-DS. Patient is 50 year old female, who had BMI of 54, and underwent gastric bypass with good result initially. Her BMI went to 23 after two years, but she regained to BMI of 47. Work up was negative for gastrogastric fistula. She underwent laparoscopic conversion to BPD-DS. Patient did well and BMI went from 47 to 36 in five months.
Previous reports of conversion of bypass to BPD-DS used EEA staplers, which can cause stricture/stenosis. We present a technique that uses all handsewn anastomoses, without the use of EEA staplers. We take down the gastojejunostomy and resize the gastric pouch and gastric remnant. We then reconstruct with three handsewn anastomoses: end to end gastrogastrostomy, end to side duodenoileostomy and side to side ileoileostomy. We create a 130cm alimentary limb and 120cm common channel. Part of the old Roux limb is left in place.
Conversion of failed gastric bypass to BPD-DS has good outcome. Studies show excess weight loss of 60% and low complication rate of 4%. The procedure is technically feasible with handsewn anastomoses without use of EEA staplers.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79159
Program Number: V138
Presentation Session: Bariatric surgery – Sleeves, Conversions and More
Presentation Type: Video