Conversion to gastric bypass and revision of cruroplasty due to persistent gastroesophageal reflux disease after initial sleeve gastrectomy and cruroplasty

Introduction: recently, dramatically increased numbers of bariatric procedures worldwide are followed by an increased incidence of revision surgeries, due to complications or failures. Objectives: To evaluate the role of laparoscopic gastric bypass in the treatment of gastroesophageal reflux disease after sleeve gastrectomy. Methods: A morbid obese, female patient, 55 years old, BMI 39 kg/m2, with concomitant HTA, hyperinsulinemia and 3 cm, non-complicated hiatal hernia, was operated in 2013 by laparoscopic sleeve gastrectomy (LSG) and concomitant hiatal hernia repair by posterior cruroplasty. 30 months afterwards a resolution of obesity and comorbidity was obtained, with BMI of 25.7 kg/m2. Meantime, symptomatic, persistent gastroesophageal reflux disease, resistant to medical treatment, with radiological confirmed hiatal hernia, was registered. Results: we present the video of laparoscopic conversion of gastric sleeve to R-en-Y gastric bypass (GBP), with concomitant revision of the posterior cruroplasty. An important improvement of the patient’s symptoms was achieved 3 months postoperatively, with suspension of medical therapy, maintained one year after intervention. Conclusions: conversion in GBP is actually the best option of treatment in case of reflux disease after LSG.