Laparoscopic Conversion of Sleeve Gastrectomy to One Anastomosis Gastric Bypass Due to Unresected Fundus and Weight Rega
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MULTIMEDIA ARTICLE
Laparoscopic Conversion of Sleeve Gastrectomy to One Anastomosis Gastric Bypass Due to Unresected Fundus and Weight Regain: Technical Considerations Ron Dar 1,2 & Tamar Dola 1 & Nasser Sakran 1,2 Received: 07 May 2020 / Revised: 09 June 2020 / Accepted: 11 June 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Keywords Morbid obesity . Sleeve gastrectomy . One anastomosis gastric bypass . Unresected fundus
Background Laparoscopic sleeve gastrectomy (LSG) has become the most common bariatric procedure worldwide [1]. However, up to 30% of patients who have undergone LSG required revision surgery for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD) [2, 3] that may be due to primary or secondary gastric dilation [4]. These complications remain the Achilles hill of this procedure. An unresected fundus is a result of inadequate operative technique. There are several options for dealing with LSG failure: re-sleeve, band on sleeve, conversion to Roux en-Y gastric bypass (RYGB), conversion to one anastomosis gastric bypass (OAGB), and conversion to biliopancreatic diversion with duodenal switch
(BPD-DS) [5–8]. Conversion to a procedure such as single anastomosis duodeno–ileal bypass with sleeve gastrectomy (SADI-s) or BPD-DS would be logical but is technically challenging [9]. RYGB remains one of the gold standards for patients with metabolic disorders and morbid obesity [10]. OAGB has been reported to have equivalent or better weight loss outcomes (due to longer biliopancreatic limb), with the added advantages of being technically simpler, and reversible procedure [11]. The patients shown in this video had their weight regained after adequate initial postopertative weight loss. The Gastrografin swallow and the upper endoscopy revealed an unresected fundus resulting from incomplete dissection without GERD. The decision for conversion to OAGB was made after discussion with both patients. This video aims to show the technical considerations of removal of the unresected fundus and conversion to OAGB.
The first two authors are considered equal. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04785-w) contains supplementary material, which is available to authorized users. * Nasser Sakran [email protected] Ron Dar [email protected] Tamar Dola [email protected] 1
Department of Surgery A, Emek Medical Center, 21 Izhak Rabin Blvd, 1834111 Afula, Israel
2
Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
Methods Patient 1 A 51-year-old female patient underwent LSG 10 years prior to reoperation for a BMI of 44 kg/m2 (117 kg), nadir of 85 kg. Due to insufficient weight loss with a BMI of 37.7 kg/m2 (100 kg), she was offered reoperation. An upper gastrointestinal series and gastroscopy revealed the presence of a distended gastric fundus and a hiatal hernia (HH) with no evidence of GERD. A decision was made for resizing the gastric sleeve and conversion
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