Short Gastric Pouch for Laparoscopic Conversion of Failed Band to Roux-en-Y Gastric Bypass

Jul 5, 2019Obesity surgery

Using a Small Stomach Pouch to Convert a Failed Weight Loss Band to a Roux-en-Y Gastric Bypass Surgery

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Abstract

A small gastric pouch is created above the gastric band scar tissue during conversion from laparoscopic gastric banding (LGB) to Roux-en-Y gastric bypass (RYGB).

Conversion from LGB to RYGB involves addressing the technical challenge of stapling in the presence of band-related scarring.
Stapling below the band can lead to complications such as a large pouch and increased risk of leaks.
Creating a pouch above the band allows for stapling on healthy tissue, which may reduce complications.
In this case, the RYGB was performed with a 150-cm alimentary limb and a 50-cm biliopancreatic limb.

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BACKGROUND: Laparoscopic gastric banding (LGB) is associated with high rate of failure (Stenard and Iannelli. World J Gastroenterol; 21:10348-57 2015, Lazzati et al. Ann Surg. 2016). In case of failure, conversion to Roux-en-Y gastric bypass (RYGB) is preferred (Noel et al. Surg Obes Relat Dis;10:1116-22; 2014, Schneck et al. Surg Obes Relat Dis;12:840-8, 2016).

METHODS: We present the case of a 63-year-old woman with a BMI of 57 kg/mwho underwent LGB in 2011. In 2015, she consulted for intolerance of the banding and weight regain, with a BMI of 52. The gastric band was removed, and 6 months later conversion to RYGB was performed. 2

RESULTS: The main technical problem of conversion of LGB to RYGB is where to staple the stomach, either below or above the band-related scarring tissue. Stapling below the band in a fresh non-scarring area often results in the creation of a large pouch; furthermore, the vertical part of the pouch stapling is done on scarring tissue, with a risk of leak. Stapling above the band leaves a very small part of stomach and may be technically challenging. The present video shows the conversion of LGB to RYGB. The hiatal region is dissected, and a small pouch stapling above the band-related scarring tissue is fashioned. An RYGB with a 150-cm alimentary limb and a 50-cm biliopancreatic limb is confectioned.

CONCLUSIONS: For conversion of LGB to RYGB, a small gastric pouch above the gastric band scar tissue is confectioned, after dissection of the hiatal region and abdominal esophagus. The small pouch ensures the restriction, and all the stapling and suturing are done on healthy, fresh tissue.

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Short Gastric Pouch for Laparoscopic Conversion of Failed Band to Roux-en-Y Gastric Bypass

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