Laparoscopic Roux-en-Y gastric bypass after vertical banded gastroplasty

Patients who have undergone bariatric surgery and present with upper abdominal symptoms pose a diagnostic and management challenge. Laparoscopic vertical banded gastroplasty (VBG) is associated with high revisional rates. In the case of failed VBG, repeat VBG seems to be a poor option and conversion to gastric bypass yields better results. This is the case of a 35-year-old female patient who underwent a vertical banded gastroplasty by laparotomy 8 years ago and presents with dysphagia. A gastroscopy and a contrast swallow exam using radio-opaque markers do not show any fistulas, but peroperative surgical exploration discovers a gastro-gastric fistula. This video clearly shows all the technical aspects of a revisional bariatric procedure.

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Laparoscopic   Roux-en-Y   gastric   bypass   after   vertical   banded   gastroplasty

Authors
M Vix, F Costantino, J Marescaux
Abstract
Patients who have undergone bariatric surgery and present with upper abdominal symptoms pose a diagnostic and management challenge.
Laparoscopic vertical banded gastroplasty (VBG) is associated with high revisional rates. In the case of failed VBG, repeat VBG seems to be a poor option and conversion to gastric bypass yields better results.
This is the case of a 35-year-old female patient who underwent a vertical banded gastroplasty by laparotomy 8 years ago and presents with dysphagia. A gastroscopy and a contrast swallow exam using radio-opaque markers do not show any fistulas, but peroperative surgical exploration discovers a gastro-gastric fistula. This video clearly shows all the technical aspects of a revisional bariatric procedure.
Catégorie
complex cases
Mots-clés
Laparoscopic Roux-en-Y gastric bypass, RYGB, vertical banded gastroplasty
Type de vidéo
Durée
16'04''
Publication
2009-04
Popularité
Favoris
Favorites Media
Audio
en es fr
Sous-titres
en
E-publication
WeBSurg.com, Apr 2009;9(04).
URL: http://www.websurg.com/doi-vd01en2596.htm

Laparoscopic   Roux-en-Y   gastric   bypass   after   vertical   banded   gastroplasty

11. Biliary and gastrojejunal anastomosis 05'00''
The gastrojejunal anastomosis is performed transorally. A gastric incision is achieved to retrieve the orogastric tube with the anvil of the circular stapler on its tip. This tube has been placed by the anesthesiologists. It is retrieved in the intra-abdominal space until the anvil is placed. The anvil is then freed from its drain. A purse-string is achieved around the passage of the anvil. The gastric pouch is ready for the anastomosis. We then go to a submesocolic position in order to prepare for the Roux-en-Y anastomosis. We measure 75cm of biliary limb. This is then fixed to the stomach and marked to be identified correctly later. 150cm of alimentary limb is then measured: it is fixed to the biliary loop in order to prepare for the anastomosis at the foot of the loop. An opening is created using the hook in each loop in order to introduce the jaws of a 60mm linear stapler, white cartridge. The introduction sites of the Endo-GIA linear stapler are re-approximated using an absorbable suture. The mesenteric defect at the foot of the loop is sutured by a non-absorbable thread. The alimentary loop is then divided by a 60mm linear stapler, white cartridge. It is opened to allow for the introduction of the circular stapler. The gastrojejunal anastomosis is then achieved by connecting the anvil with the circular stapler. The introduction site of the circular stapler is closed once the blind extremity of the Roux-en-Y loop has been shortened using a linear stapler, white cartridge. The extremity of the resected Roux limb is also placed in the bag containing the gastric specimen. The line of staples internal to the circular anastomosis is strengthened by two stitches. Two stitches are placed on each side of the gastrojejunal anastomosis.