Laparoscopic hand-sewn re-gastrojejunostomy for complicated Roux-en-Y gastric bypass
Epublication WebSurg.com, May 2013;13(05). URL: http://websurg.com/doi/vd01en3960
Introduction: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a popular bariatric procedure associated with potential risk of late complications such as anastomotic stricture, marginal ulceration, fistula formation, weight gain, and nutritional deficiencies. A 48-year-old woman submitted to LRYGB 1.5 year before, presented a marginal ulcer of the gastrojejunostomy, non-responsive to medical therapy, associated with total dysphagia and cachexia. At the time of LRYGB, a linear stapled side-to-side gastrojejunostomy has been performed. Video: The revision was completed using 4 abdominal trocars and consisted in these successive steps: adhesiolysis between the left liver lobe, gastrojejunostomy and gastric pouch; identification of right crus and lower esophagus; mobilization of the stoma and gastric pouch from both crura, transverse colon and gastric remnant; division of the gastric pouch above the stoma with preservation of the left gastric vessels; division of the proximal alimentary limb under the stoma; new double-layer hand-sewn gastrojejunostomy (PDS 1 externally, PDS 2/0 internally); hiatoplasty; leak test; specimen’s removal through trocar enlargement. Results: No perioperative complications or additional trocars were registered. Operative time was 157 minutes and estimated blood loss 20 cc. The postoperative course was uneventful and patient was discharged on postoperative day 3. After 1 year, the patient is well and tolerates a regular diet. Conclusions: Postoperative complications after LRYGB, such as marginal ulcer, can be safely treated by laparoscopy. New hand-sewn anastomosis permits to control the stoma openings and to calibrate the anastomosis size, especially in case of small gastric pouch.