Artikel
Revisional Surgery: Technical Aspects of One-Step Transforming Failed Gastric Band (LGB) and Vertical Banded Gastroplasty (VBG) to Laparosopic Roux-en-Y Gastric Bypass
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Autoren
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Ricardo Zorron
- Klinikum Bremerhaven Reinkenheide, Division Innovative Surgery, Klinik für Allgemein-, Viszeral-, Thorax- und Gefässchirurgie, Bremerhaven
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Claudia Bothe
- Klinikum Bremerhaven Reinkenheide, Division Innovative Surgery, Klinik für Allgemein-, Viszeral-, Thorax- und Gefässchirurgie, Bremerhaven
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Elena Junghans
- Klinikum Bremerhaven Reinkenheide, Division Innovative Surgery, Klinik für Allgemein-, Viszeral-, Thorax- und Gefässchirurgie, Bremerhaven
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Tido Junghans
- Klinikum Bremerhaven Reinkenheide, Division Innovative Surgery, Klinik für Allgemein-, Viszeral-, Thorax- und Gefässchirurgie, Bremerhaven
| Veröffentlicht: | 21. März 2014 |
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Gliederung
Text
Objectives: 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 laparoscopic gastric banding (LGB) and vertical banded gastroplasty (VBG) have a higher failure rate in achieving adequate weight loss, and conversion to LRYGB can potentially be beneficial in patients with inadequate results. This present video enphasises the technical aspects of transforming LGB and VBG in LRYGB.
Methods: The video shows fundamental surgical steps in transforming LGBs and VGBs to LRYGB, in morbidly obese patients (BMI 45.3 to 57 kg/m2 submitted to restrictive procedure more than 2 years before and inadequate weight loss. Technical steps included:
- 1.
- Fully adhesiolysis and dissection of the small curvature including hiatus;
- 2.
- Liberation of the hiatus and upper greater curvature with ultrassonis energy;
- 3.
- Resection of the band and fibrous tissue and creating a small stapled gastric pouch over a 32Fr Bougie;
- 4.
- Handsewn gastrojejunal anastomosis PDS 3.0 at 70 cm, stapled jejuno-jejunal anastomosis at 150 cm; and
- 5.
- Leak testing with methylene blue and drainage.
Results: Mean operative time was 266 min. Operative blood loss was less than 50ml. There were no intraoperative complications. As postoperative complication, one patient was reoperated due to partial rupture and perforation of the Roux-en-Y anastomosis at 3 months after massive volume meal and recovered well. One patient received non-therapeutic relaparoscopy in the 2nd postoperative day. Follow-up showed adequate excess weight loss by 6 months and ameliorating of co-morbidities.
Conclusions: One-step revision to LRYGB of failed restrictive bariatric procedures represents the state of the art in achieving optimal results in weight loss and controlling co-morbidities. Careful identification of the altered anatomy and handsewing skills are important preconditions for the surgeon in performing advanced revisional procedures in bariatric surgery.
