Dr. Ainitze Ibarzabal Olano and her team at Hospital Clínic, Barcelona perform a revisional RNYGB to a 55-year-old male patient who underwent a Sleeve Gastrectomy in 2015.
A 55-year-old male patient who underwent a Sleeve Gastrectomy in 2015. Currently, the patient presents with severe gastroesophageal reflux unresponsive to medical treatment. The patient is scheduled for revisional surgery, and conversion to RYGBP was proposed.
Clinical History:
Clinical Background
55-year.old man
Previous Sleeve Gastrectomy in 2015 with a BMI of 44 Kg/m² due to hepatomegaly secondary to NAFLD. At the time of Sleeve the patient had high blood pressure, diabetes mellitus with oral antidiabetics and sleep apnea
Currently the patient has a BMI of 30 Kg/m², no comorbidities and presents refractory gastroesophageal reflux refractory to medical treatment. The barium swallow also showed a paraesophageal hernia. An upper endoscopy showed no mucosal injury and, after functional testing , the patient has a De Meester score of 7.7 with no impairment in esophageal motility
Technique Description
Technique Description:
We will perform a revisional RNYGB with hiatal hernia repair
Procedure Steps:
Patient in supine position, open legs, and reverse Trendelenburg
Pneumoperitoneum creation
Laparoscopic port placement
Dissection of the hiatal hernia and creation of the gastric pouch
Introduction of the anvil
Section of great omentum and identification of jejunum for the anastomosis
Creation of the gastro-jejunal anastomosis (circular)
Creation of the jejuno-jejunal anastomosis (linear)
Training Objectives:
Tips for revisional RNYGB after sleeve gastrectomy with hiatal hernia repair
Indications and patient selection
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