- Roux-en-Y gastric bypass (RYGB) is an effective treatment for morbid obesity and gastroesophageal reflux disease (GERD)  Despite majority of patients with resolution of GERD after RYGB, some patients will continue to complain of significant, persistent reflux symptomatology or develop de novo symptoms despite aggressive medical management. Its true incidence is unknown and 1 study showed an improvement in GERD but not resolution in 22% of patients after RYGB with GERD . Possible mechanisms may include primary lower esophageal sphincter incompetence, disruption of the angle of His, or development of hiatal hernia with intrathoracic migration of the gastric pouch.
- Intussusception after Roux-en-Y gastric bypass (RYGB) is a rare, long-term complication most commonly occurring in a retrograde fashion just distal to the jejunojejunostomy with approximately .5% incidence . Management options include reduction, pexy, and resection of jejunojejunostomy [2–4]. Our traditional approach in management of symptomatic intussusception is resection and creation of new jejunojejunostomy,y preferably end-to-side anastomosis with a smaller anastomosis of <60 mm. In this video, we compare 2 techniques used to resect the anastomosis.
- 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.