Laparoscopic revision of gastric bypass for gastrojejunal anastomotic stenosis and trans-mesocolic defect: video report

Obes Surg. 2015 May;25(5):948. doi: 10.1007/s11695-015-1616-8.

Abstract

Purpose: Laparoscopic gastric bypass (LRYGB) is considered as the gold standard procedure for morbid obesity because of sustainable weight loss and coexisting conditions improvements (Sjostrom L et al. The New England journal of medicine 351(26):2683-93, 2004 [1]; Thereaux J et al. Surg Obesity Related Dis: Off J Am Soc Bariatric Surg, 2014 [2]). However, there are some concerns with the late risk of gastrojejunal anastomotic stenosis and of small bowel obstruction (Hamdan K et al. 98(10):1345-55, 2011 [3]).

Materials and methods: We present the case of a 46-year-old woman (70 kg, 1.67 m) with a body mass index (BMI) of 25.1 kg/m(2) who had undergone LRYGB, 3 years ago (initial BMI 45 kg/m(2)). She was referred to our tertiary care center for dysphagia and abdominal pain.

Results: In this multimedia video, we present a step-by-step laparoscopic revision of a LRYGB for gastrojejunal anastomotic stenosis associated with trans-mesocolic defect. Procedure included dissection and resection of the strictured anastomosis, redo gastrojejunal circular anastomosis, and closure of the trans-mesocolic defect. No adverse outcomes occurred during the postoperative period.

Conclusion: Gastrojejunal anastomosis stenosis should be managed under laparoscopy. All abdominal surgery in patients with a history of LRYGB, especially with trans-mesocolic alimentary limb, should include inspection of potential meso-defect.

Publication types

  • Case Reports

MeSH terms

  • Body Mass Index
  • Constriction, Pathologic / surgery
  • Female
  • Gastric Bypass / methods
  • Humans
  • Intestine, Small / surgery
  • Jejunum / surgery*
  • Laparoscopy / methods
  • Middle Aged
  • Obesity, Morbid / surgery
  • Postoperative Complications / surgery*
  • Reoperation
  • Video Recording
  • Weight Loss