Combined Laparoscopic Revision of the Gastric Pouch and Distalization of the Roux Limb After Failure of Weight Loss Foll
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MULTIMEDIA ARTICLE
Combined Laparoscopic Revision of the Gastric Pouch and Distalization of the Roux Limb After Failure of Weight Loss Following Roux-en-Y Gastric Bypass Tarek Debs 1,2 & Sebastien Frey 1,2 & Niccolo Petrucciani 3 & Clement Fortier Beaulieu 4 & Fabrice Lame 5 & Antonio Iannelli 1,2 & Eric Sejor 1,2 & Imed Ben Amor 1,2 & Jean Gugenheim 1,2
# Springer Science+Business Media, LLC, part of Springer Nature 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. Keywords Surgical technique . Roux-en-Y gastric bypass . Failure of weight loss . Gastric pouch resizing Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04476-6) contains supplementary material, which is available to authorized users. * Tarek Debs [email protected]
Imed Ben Amor [email protected]
Sebastien Frey [email protected]
Jean Gugenheim [email protected]
Niccolo Petrucciani [email protected] Clement Fortier Beaulieu [email protected] Fabrice Lame [email protected] Antonio Iannelli [email protected] Eric Sejor [email protected]
1
Université Côte d’Azur, Nice, France
2
Digestive Surgery and Liver Transplantation Unit, Centre Hospitalier Universitaire de Nice, Archet 2 Hospital, University of Nice, Sophia-Antipolis, 151 Route de Saint-Antoine, 06200 Nice, France
3
Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University of Rome, Rome, I
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