Multimedia Library
Laparoscopic modified Nissen fundoplication over Roux-en-Y gastric bypass and hiatal hernia repair for intractable gastroesophageal reflux
Roux-en-Y gastric bypass (RYGB) is an effective treatment for morbid obesity and gastroesophageal reflux disease (GERD) [1] 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 [2]. 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.Laparoscopic resection of intussusception after Roux-en-Y gastric bypass: comparison between the conventional and a simplified approach
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 [1]. 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.Pneumatic dilation for functional helix stenosis after sleeve gastrectomy: long-term follow-up (with videos)
A large number of patients who undergo laparoscopic sleeve gastrectomy present with surgical complications. Stenosis, in particular, occurs in .7%–4% of cases.Fifth International Consensus Conference: current status of sleeve gastrectomy
For the purpose of building best practice guidelines, an international expert panel was surveyed in 2014 and compared with the 2011 Sleeve Gastrectomy Consensus and with survey data culled from a general surgeon audience.Anastomotic techniques in open Roux-en-Y gastric bypass: primary open surgery and converted procedures
Open Roux-en-Y gastric bypass (RYGB) may be chosen because of known widespread adhesions or as a result of conversion during laparoscopic surgery. Although conversions are rare, they occur even in experienced hands. The gastrojejunostomy may be performed with a circular stapler (CS) or a linear stapler (LS) or may be entirely hand sewn (HS). Our aim was to study differences in outcomes regarding the anastomotic techniques utilized in open surgery.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].Lassoing of the small bowel mesentery and abdominal pain caused by band tubing after “band on bypass”
Weight regain after laparoscopic gastric bypass can be difficult to manage. A common finding is an enlarged gastrojejunal complex (dilated gastric pouch and/or jejunum, dilated gastrojejunal anastomosis). Revision of the gastrojejunal complex can be accomplished by surgical resection [1], endoscopic plication techniques [2], or more recently, placement of an adjustable band around the dilated gastric pouch (“band on bypass,” BoB). We present an unusual complication of the BoB procedure, in which the band tubing looped around the small bowel causing severe abdominal pain.Late gastric perforation after insertion of intragastric balloon for weight loss—video case report and literature review
The BioEnterics intragastric balloon (BIB) is used in the treatment of morbid obesity, as a method for short-term weight loss, especially before definitive surgery. Previous studies have demonstrated that patients who have a BIB inserted can achieve ≤48% reduction of their excess weight, although this is not maintained in the long term [1–5]. The BIB is recommended to stay in place for 6 months and either removed or replaced after that period, because the risk of spontaneous rupture owing to material degradation increases.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.Abdominal pain 1 month after adjustable gastric banding: an unusual complication caused by connecting tubing
Complications related to the laparoscopic adjustable gastric band connecting tubing are rare, with presentations that are not always obvious and an evaluation that is not always straightforward. Internal hernias and adhesions caused by the tubing are more uncommon and equally challenging to diagnose. The judicious use of diagnostic laparoscopy for unexplained abdominal pain related to the laparoscopic adjustable gastric band can be life-saving.Technique for nonfascial fixation of the laparoscopic adjustable gastric band access port
Access port complications occur in 10–20% of patients undergoing laparoscopic adjustable gastric banding (LAGB). These have included infection, leakage, difficult access, erosion, pain, and poor cosmetic results requiring revision. Additionally, traditional fascial fixation techniques require longer operative times and fluoroscopic or ultrasound localization, increasing the time, expense, and discomfort associated with LAGB. We report a technique of nonfascial fixation of the LAGB access port with minimal complications.Video case report: multiple intraperitoneal transections of Lap-Band tubing with descending colon inflammation: cause or effect?
We present the case of a patient with a rare complication of laparoscopic gastric banding. The patient presented with vague, left-sided abdominal pain 23 months after Lap-Band (Allergan, Irvine, CA) placement. Radiographic studies revealed complete disruption of the intraperitoneal Lap-Band tubing with descending colonic inflammation. Operative exploration revealed an abnormally stiff section of tubing with 1 complete transection and another partial disruption, neither of which were located at the connector site.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 management of chronic gastric pouch fistula after laparoscopic gastric bypass
We present the case of a 47-year-old man who had undergone uneventful antecolic antegastric laparoscopic Roux-en-Y gastric bypass (LRYGB) in June 2002 for super morbid obesity. Ten months later, laparoscopic reduction of an internal hernia at the jejunojejunostomy was performed for an acute small bowel obstruction. Three months later, he underwent laparoscopic gastric pouch trimming for failure of weight loss, epigastric pain, marginal ulceration, and an increasing ability to tolerate larger food volumes with pouch dilation.
