Purpose: After failed Roux-en-Y gastric bypass (RYGB), the choice of a secondary procedure falls into many pathways: revision of the gastric pouch, distalization of the bypass (DRYGB), addition of an adjustable gastric band, and conversion to a duodenal switch (BPD/DS). Material and Methods: We present the case of a 54-year-old man with initial BMI of 51.5 kg/m2, who first underwent laparoscopic sleeve gastrectomy (SG) in 2010. In 2012, he underwent a RYGB procedure, and in 2015, a pouch resizing for weight regain. In 2018, he reached a BMI of 41.2 kg/m2. A 3D volumetric CT scan measured a gastric pouch volume of 220 cm3 and a gastrojejunal anastomosis diameter of 20 mm. Results: As shown in the video, the patient underwent a combined revision of the gastric pouch and the gastrojejunal anastomosis associated to the distalization of the Roux limb. The gastrojejunal anastomosis is identified, and vertical division of the stomach is performed along a 36 French bougie, in order to create a 30 cm3 gastric pouch. Then, the jejunojejunal anastomosis is identified, and the Roux limb at the jejunojejunostomy is divided and transposed distally 100 cm to create a total alimentary length of 250 cm. The postoperative course was uneventful. At 1 year, his BMI was 31.2 kg/m2. No nutritional deficiencies were noted. Conclusion: Combined laparoscopic pouch resizing and distalization are safe and can lead to adequate weight loss. This technique allows the combination of an added restriction and malabsorption to the previous RYGB and could lead to an improved weight loss.

Combined Laparoscopic Revision of the Gastric Pouch and Distalization of the Roux Limb After Failure of Weight Loss Following Roux-en-Y Gastric Bypass / Debs, Tarek; Frey, Sebastien; Petrucciani, Niccolo; Fortier Beaulieu, Clement; Lame, Fabrice; Iannelli, Antonio; Sejor, Eric; Amor, Imed Ben; Gugenheim, Jean. - In: OBESITY SURGERY. - ISSN 0960-8923. - :Apr 26(2020), pp. 1-3. [10.1007/s11695-020-04476-6]

Combined Laparoscopic Revision of the Gastric Pouch and Distalization of the Roux Limb After Failure of Weight Loss Following Roux-en-Y Gastric Bypass

Petrucciani, Niccolo
;
2020

Abstract

Purpose: After failed Roux-en-Y gastric bypass (RYGB), the choice of a secondary procedure falls into many pathways: revision of the gastric pouch, distalization of the bypass (DRYGB), addition of an adjustable gastric band, and conversion to a duodenal switch (BPD/DS). Material and Methods: We present the case of a 54-year-old man with initial BMI of 51.5 kg/m2, who first underwent laparoscopic sleeve gastrectomy (SG) in 2010. In 2012, he underwent a RYGB procedure, and in 2015, a pouch resizing for weight regain. In 2018, he reached a BMI of 41.2 kg/m2. A 3D volumetric CT scan measured a gastric pouch volume of 220 cm3 and a gastrojejunal anastomosis diameter of 20 mm. Results: As shown in the video, the patient underwent a combined revision of the gastric pouch and the gastrojejunal anastomosis associated to the distalization of the Roux limb. The gastrojejunal anastomosis is identified, and vertical division of the stomach is performed along a 36 French bougie, in order to create a 30 cm3 gastric pouch. Then, the jejunojejunal anastomosis is identified, and the Roux limb at the jejunojejunostomy is divided and transposed distally 100 cm to create a total alimentary length of 250 cm. The postoperative course was uneventful. At 1 year, his BMI was 31.2 kg/m2. No nutritional deficiencies were noted. Conclusion: Combined laparoscopic pouch resizing and distalization are safe and can lead to adequate weight loss. This technique allows the combination of an added restriction and malabsorption to the previous RYGB and could lead to an improved weight loss.
File allegati a questo prodotto
File Dimensione Formato  
Debs_Combined-Laparoscopic_2020.pdf

solo gestori archivio

Tipologia: Versione editoriale (versione pubblicata con il layout dell'editore)
Licenza: Tutti i diritti riservati (All rights reserved)
Dimensione 172.15 kB
Formato Adobe PDF
172.15 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1390745
Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus 2
  • ???jsp.display-item.citation.isi??? 2
social impact