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Laparoscopic Roux-en-Y gastric bypass after gastric band removal with severe small bowel adhesions

M Vix, MD J Marescaux, MD, FACS, Hon FRCS, Hon FJSES, Hon FASA, Hon APSA
Epublication WebSurg.com, Oct 2014;14(10). URL: http://websurg.com/doi/vd01en4331

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  • 2014-10-14
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After gastric band removal, a laparoscopic Roux-en-Y gastric bypass is rendered more difficult by the existence of adhesions between the liver, the superior part of the stomach, and potentially the spleen. This video describes how to handle difficulties in dissecting the superior part of the stomach. Dissection of the cardia and left crus are required to allow for an appropriate calibration of the gastric pouch. The difficulty is subsequently increased in this patient as there are dense small bowel adhesions related to a previous history of gynecologic peritonitis. The intervention has been entirely performed laparoscopically. Small bowel adhesions have been taken down in order to obtain a sufficient free length (approximately 2 meters) and perform a jejunojejunostomy in adequate conditions.