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Laparoscopic revision of a transected silastic vertical gastric bypass (Fobi pouch) with totally hand sewn gastrojejunostomy for complicated marginal ulcer
Transected silastic vertical gastric bypass (Fobi pouch bypass) is a modified open gastric bypass, introduced by Dr. Mathias Fobi in 1990s. Although long-term weight maintenance is excellent, it was not widely adopted by bariatric surgeons in the minimally invasive era. This video illustrates a laparoscopic approach to a particularly complicated marginal ulcer that was eroding into the liver and pancreas.Laparoscopic Heller myotomy after previous Roux-en-Y gastric bypass
Obesity has been shown to be an independent risk factor for developing esophageal motility disorders, with a prevalence of 20% to 61% [1–4]. Achalasia is a rare primary esophageal motility disorder that is even more rare among the obese population. It is characterized by aperistalsis of the esophagus and lack of relaxation of the lower esophageal sphincter. Associated symptoms in the nonobese patient include dysphagia, regurgitation, reflux, and weight loss. On the contrary, among the obese population regurgitation, cough and aspiration are the presenting symptoms.Laparoscopic revision of transoral endoscopic vertical gastroplasty to Roux-en-Y gastric bypass
There are a number of endoscopic bariatric therapies, which have been proven to be safe and effective in the treatment of obesity [1]. The transoral endoscopic vertical gastroplasty (TOGA) is an endoscopic procedure in which flexible instruments are introduced through the mouth, passed to the stomach, and used to acquire tissue along the anterior and posterior stomach walls, fold the tissue, and staple it to create a restrictive pouch [2]. This procedure has been shown to be safe and produce up to 44.8% excess weight loss at one year [2,3].Laparoscopic revision of chronic marginal ulcer and bilateral truncal vagotomy
In accredited centers, bariatric surgery is performed with very low mortality, morbidity, and readmission rates [1–3]. However, a small number of bariatric patients develop postoperative complications such as marginal ulcers. Previous reports cite the incidence of marginal ulcer with significant variability, from .6% to 16% [4]. The etiology of marginal ulcers after a laparoscopic Roux-en-Y gastric bypass is a matter of debate. Many factors are believed to contribute to the development of marginal ulcers, such as smoking, ischemia, foreign body reaction, gastrogastric fistulas, large gastric pouches, and tension at the anastomosis [5–9].Laparoscopic hand sewn regastrojejunostomy for complicated Roux-en-Y gastric bypass
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a popular bariatric procedure associated to potential risk of late complications like anastomotic marginal ulceration, stricture, fistula formation, weight gain, and nutritional deficiencies [1–6].Endoscopic neogastrogastrostomy in a postgastric bypass patient by application of an endoscopic antegrade–retrograde rendezvous technique
The patient, a 45-year-old woman, initially underwent Roux-en-Y gastric bypass for morbid obesity. Three years later, it was complicated by a gastrojejunostomy ulcer with perforation requiring local repair. Additional complications with ischemic bowel and subsequent surgical revisions resulted in complete gastric outlet obstruction. A venting gastrostomy tube was placed in the gastric pouch, and a feeding gastrostomy tube was surgically placed in the gastric remnant. After some time, the patient strongly expressed her desire to eat orally.Laparoscopic revision of gastrojejunostomy and vagotomy for intractable marginal ulcer after revised gastric bypass
The incidence of marginal ulceration after gastric bypass has been reported with significant variability (1–16%) [1]. Although its pathogenesis is unclear, several factors are associated with ulcer formation, including acid exposure, ischemia, foreign body, medications, and tobacco. In general, pharmacologic therapy is highly effective for ulcer healing, and surgical intervention is usually reserved for complications—typically bleeding or perforation. Rarely, surgical intervention is indicated for cases refractory to medical therapy.Malrotation—an unexpected finding at laparoscopic Roux-en-Y gastric bypass: a video case report
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is 1 of the most common procedures performed for severe obesity. Incidental anatomic abnormalities found at surgery are uncommon and can require an alternative operative approach. We present a video case report of a patient incidentally found to have midgut congenital malrotation at LRYGB.Plication followed by resection for intussusception after laparoscopic gastric bypass
Laparoscopic Roux-en-Y gastric bypass is the most commonly performed surgical intervention for morbid obesity. Internal hernias are the most common cause of postoperative bowel obstruction after laparoscopic Roux-en-Y gastric bypass, with a reported incidence of 3.1% despite mesenteric defect closure [1,2]. A less common cause of postoperative bowel obstruction is small bowel intussusception.Laparoscopic repair of internal hernia during pregnancy after Roux-en-Y gastric bypass
Laparoscopic Roux-en-Y gastric bypass as a treatment of severe obesity has increased dramatically in the past decade, and most of the patients have been women [1,2]. The health risks experienced by obese women during pregnancy can be reduced by the weight loss induced by bariatric surgery [3–5], but these patients are at risk of bariatric surgical complications during their pregnancies. Women who have undergone Roux-en-Y gastric bypass for morbid obesity are at risk of internal hernias, intussusception, and small bowel obstruction during pregnancy, which can lead to maternal and/or fetal death [6].Laparoscopic Roux-en-Y gastric bypass after previous Nissen fundoplication
The prevalence of both gastroesophageal reflux disease (GERD) and obesity has increased significantly during the past 25 years, and an association between the 2 has been demonstrated [1–6]. Laparoscopic Nissen fundoplication has been shown to be safe and effective in the treatment of GERD and to offer significant advantages compared with long-term medical therapy [7–12]. However, it might have decreased efficacy in morbidly obese patients [13,14]. Thus, an increasing number of patients might require a bariatric procedure after previous Nissen fundoplication, whether for weight loss or recurrent reflux [15].Laparoscopic reduction of small bowel intussusception in a 33-week pregnant gastric bypass patient: surgical technique and review of literature
Intussusception is a rare etiology of bowel obstruction in adults and accounts for 1–3% of those cases. It is associated with an underlying mass such as a tumor or polyp in >80% of patients [1–4]. In gastric bypass patients, intussusception is an uncommon complication [5,6]. The common channel distal to the jejunojejunostomy is the usual site of intussusceptions. The direction of intussusception can be either antegrade or retrograde, but most reported cases are retrograde in nature. The probable etiology can include the presence of an ectopic pacemaker causing retrograde peristalsis.Intussusception after laparoscopic Roux-en-Y gastric bypass
Roux-en-Y gastric bypass (RYGB) has become one of the preferred surgical options for morbid obesity and has been proved effective [1,2]. Laparoscopic RYGB was first introduced by Wittgrove et al. [3] in 1994. Laparoscopic RYGB remains a challenging procedure because of postoperative complications associated with high morbidity and mortality. We describe 1 case of intussusception after laparoscopic RYGB.Gastric bypass for severe obesity: Approaches and outcomes
Bariatric surgery has experienced unprecedented growth in the United States during the last 10 years [1]. Compared with the late 1980s and early 1990s, when approximately 15,000 bariatric operations were performed each year, in 2003 more than 100,000 bariatric operations were performed in the United States. This growth in bariatric surgery, the fastest-growing major operation in the United States, can be explained by 3 factors: (1) the 4-decades-old epidemic of obesity, (2) steadily improving outcomes for several bariatric operations, and (3) the introduction of laparoscopic bariatric surgery with improved perioperative outcomes.
