Gastro-jejunal sleeve/redo gastro-entero

The preview medical information was about a case of weight recidivism after an Open Biliopancreatic Diversion (BPD) procedure performed 20 years ago on a patient with a BMI of 49.6 kg/m2 who reached a nadir BMI of 23 kg/m2 and presented weight recidivism returning to a BMI of 44.1 kg/m2. Patient presented with a good nutritional status, with a light anemia, no diarrhea, and no malodorous gas or feces. Surgery started with a pneumoperitoneum performed with a Veress needle and placement of the trocars. As the first procedure was open there were many adhesions to remove. Although the information was that the first procedure was a BPD, with the progress of the dissection it could be seen that the real surgery had been a Gastric Bypass with transmesocolic retrogastric reconstruction. For these cases a good strategy is moving the dissection to the retrogastric space by dividing the greater curvature vessels that will allow a direct approach to the alimentary limb. Finally, after adhesion removal, a banded long and wide pouch, a 4 cm gastrojejunostomy, and a large candy cane were found. Once we examined the anatomy, we decided to resize the resizing of the pouch and perform a new gastrojejunostomy. The pouch dissection started by approaching the smaller curve, reaching the retrogastric space, making it possible to staple with the green cartridge, reducing pouch length to 3 cm, and reducing pouch width to 2 cm with the vertical staple. Reinforcement of these staple lines was ensured by using the Seamguard. The alimentary limb was divided in order to resect part of pouch and the candy cane, and a new 15 mm gastrojejunostomy was performed. A methylene blue test was performed with a negative result. The highlights of the video could be linked to the importance of having a good previous surgical report in order to make the procedure easier – exactly the opposite than in this case, in which the information provided was not correct. It is very important to proceed with a wide dissection and a clear anatomy in order to have all the information so as to make the best decision about the procedure strategy.

Clinical Case:

Clinical Background

• 52-year-old man

• 124.6 kg, 183 cm, BMI 44.1

• Current problem: weight regain

Technique Description