gms | German Medical Science

Introduction: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is currently the most performed primary bariatric procedure for morbid obese patients, with good postoperative results and achieving adequate excess weight loss (EWL). Purely restrictive techniques as vertical banded gastroplasty (VBG) have a higher failure rate in achieving adequate weight loss, and LRYGB can potentially correct the limitations of the technique in patients with inadequate results. This present video enphasises the technical aspects of transforming VBG in LRYGB.

Material and methods: The video shows fundamental surgical steps in transforming VBG to LRYGB, in a 38yr-old female patient who was submitted to open vertical banded gastroplasty Mason 13 years before. BMI was 56.4 Kg/m2 (Height 1.58m, weight 141Kg), and the patient achieved weight loss of only 7Kg in the period. Co-morbidities were controlled hypertension, hypertrigliceridemy and articular disease. Technical steps included: 1. Fully adhesiolysis and dissection of the small curvature including hiatus; 2. Liberation of the hiatus and upper greater curvature with Thunderbeat energy; 3. Lefting the band in place, lefting the previous stapling in place and creating a small stapled gastric pouch over a 32Fr Bougie. 4. Handsewn gastrojejunal anastomosis PDS 3.0 at 70cm, stapled jejuno-jejunal anastomosis at 120cm; and 5. Leak testing with methylene blue and drainage.

Results: Operative time was 270 min due to severe adhesions. Operative blood loss was less than 50ml. Intraoperative there was a leaking from the gastrojejunal anastomosis detected by leak test with blue ink and corrected by reinforcing the suture. As postoperative complication the patient presented a transitory compression right cubital neuralgia, and was dismissed on the 6^th postoperative day. The patient recovered well and had no further complications in the short follow up period.

Conclusion: Laparoscopic revision to LRYGB of failed bariatric procedures as VBG seems possible also for previously conventional operated cases. Careful identification of the altered anatomy and handsewing skills are important preconditions for the surgeon in performing advanced revisional procedures in bariatric surgery.