Video

Video 81.5 Revisional bariatric surgery one-step transforming failed gastric band, vertical banded gastroplasty (Mason), and sleeve gastrectomy to Roux-en-Y gastric bypass

Revisional bariatric surgery: one-step transforming failed gastric band (LGB), vertical banded gastroplasty (Mason, VBG), and sleeve gastrectomy (LSG) to Roux-en-Y gastric bypass (LRYGB). Revision from failed bariatric restrictive procedures to LRYGB produces an effective result in achieving excess weight loss and reducing comorbidities. The video shows fundamental surgical steps in transforming LGBs, VGBs, and LSGs to LRYGB, in morbidly obese patients (BMI 45.3 to 57 kg/m2) submitted to restrictive procedure more than 2 years before and with inadequate weight loss. Technical steps included: (1) full adhesiolysis and dissection of the small curvature including hiatus; (2) liberation of the hiatus and upper greater curvature with ultrasonic energy; (3) resection of the band and fibrous tissue and creating a small stapled gastric pouch over a 32 Fr bougie; (4) hand-sewn gastrojejunal anastomosis, PDS 3.0, at 70 cm from the Treitz ligament, stapled jejunojejunal anastomosis at 150 cm; and (5) leak testing with methylene blue and drainage. Careful identification of the altered anatomy and hand-sewing skills are important preconditions for the surgeon in performing advanced revisional procedures in bariatric surgery.