Conversion to RNY Gastric Bypass

Progressive dysphagia is a known complication of the VBG due to the presence of the ring that has been placed. A recurrence of the sliding hernia after a Nissen fundoplication is also a well-described entity. Unfortunately, our patient experienced both problems concomitantly. Our theory is that the recurrence of the sliding hernia aggravated the dysphagia caused by the earlier placed ring of the VBG. The symptoms have grown gradually worse over the years. The patient’s weight regain, which augments intra-abdominal pressures will not have helped in this matter. In order to alleviate all of our patients’ problems we needed to tackle this case from every angle. Firstly, to make sure the dysphagia and vomiting is gone the ring will have to be removed. To ensure alleviation of her reflux we needed to reduce the hernia. Lastly, because of her weight regain extra measures needed to be taken. Adding more restriction alone would not have helped this patient who already complains of dysphagia and vomiting, so we opted for a conversion to a Roux-en-Y gastric bypass. This is still the gold standard treatment for GERD in the obese population, will result in a significant weight loss and - when the pouch is constructed above the formerly placed ring - her dysphagia and vomiting will also subside.

Clinical Case:

Clinical Background

• 51-year-old woman

• 88.8 kg, 166 cm, BMI 32.2

• Current problem: frequent vomiting and reflux

Technique Description