Revisional Bariatric Surgery: from gastric band to robot-assisted Roux-en-Y gastric bypass

S. Ayloo, R. Kakarla, G. Contino, M. El Zaeedi, PC. Giulianotti

Introduction: Adjustable gastric banding (LAGB) is an effective surgical procedure for morbid obesity. Yet revisional bariatric procedure has been on rise with patients who has failed to achieve successful weight loss with initial surgery. We present a technical video of conversion of adjustable gastric banding to roux-en-y gastric bypass (RYGBP) with robotic approach with single docking. Methods A 46-year old woman who underwent a LAGB 5 years ago with several adjustments and current BMI 44, failed in achieving adequate weight loss presented for revisional bariatric surgery. The patient choose to proceed with RYGBP. Results The procedure began with a diagnostic laparoscopy. Extensive adhesiolysis was performed laparoscopically. The daVinci system was docked cranially and proceeded with releasing the adjustable gastric band. A Gastric pouch was created using endo GIA staplers. A double layer hand sewn gastro-jejunal anastomosis was created in omega 30 cm from Treitz ligament. Then a latero-lateral jejuno-jejunostomy was done with stapler and hand sewn suture. The afferent loop was then transected creating a Roux-en-Y. An endoscopic evaluation of the stomach and air leak test was performed, confirming integrity of the gastro-jejunal anastomosis. There were no intra- or post-operative complications. Conclusions The conversion of gastric band to RYGBP is a valid therapeutic option for patients with no substantial weight loss from their initial surgery. Revisional bariatric surgery can be performed safely and the robotic technology is a useful option in redo surgery, allowing for accurate, precise, fine dissection, with the advantage of a 4th arm assisting in retraction and exposure in a distorted anatomy.