- Conversion of Nissen fundoplication to Roux-en-Y gastric bypass can be technically challenging due to factors present for any reoperation, such as presence of scar tissue, altered tissue planes, and often unclear anatomy. Meticulous hiatus and wrap dissection, repair of hiatal hernia if present, complete unwrapping of the fundoplication and clarification of gastric redundancy before pouch creation, and preservation of the left gastric artery are keys to improving outcomes and reducing morbidity.
- The patient is a 41-year-old woman who had undergone multiple bariatric surgeries outside of our instituation. She has a remote history of a Roux-en-Y gastric bypass followed by placement of an adjustable gastric band over the gastric pouch. This was undertaken to mitigate the weight gain that had ensued over the years after her bypass. She presented to our hospital with abdominal pain. Further workup revealed her band to be eroded into her gastric pouch. This was removed endoscopically. On subsequent endoscopy for workup of persistent abdominal pain and heartburn, she was noted to have gastrogastric and gastroenteric fistulas.
- A 48-year-old woman had undergone placement of a laparoscopic adjustable gastric band (LAGB) 5 years ago at another facility. Her preoperative weight was 138 kg, with a body mass index (BMI) of 52 kg/m2. A year later, she developed a subcutaneous port site infection. The port was removed at that time, but the band was left in place. She subsequently presented with generalized peritonitis and underwent exploratory laparotomy without removal of the gastric band. She was referred to us after she was found to have an eroded band on esophagogastroduodenoscopy (EGD) done for evaluation of chronic abdominal pain.