Revisional Bariatric Surgery: from Gastric Band to robotic assisted-Laparoscopic Sleeve Gastrectomy
June 20, 2012
S. Ayloo, F. Gheza, D. Calatayud, PC. Giulianotti
Introduction: The Gastric Banding is the most diffused procedure for morbid obese patients. Sometimes the weight loss is not appropriate, requiring a new therapeutic. We present here a video using the robotic assisted laparoscopic approach to convert a gastric banding to Sleeve gastrectomy. Methods This 43-year old woman underwent laparoscopic adjustable gastric banding five years ago with 10 different adjustments without any benefits and a current BMI of 44. We plan to convert the procedure in a fully robotic sleeve gastrectomy. Results The pneumoperitoneum was achieved and a diagnostic laparoscopy was performed. The procedure started dissecting the scar tissue around the gastric band, which was then cut and removed from the abdomen. A vertical tubular gastrectomy was performed using a 38 French Bougie as a calibrator with multiple loads of the Endo-GIA stapler with GORE? reinforcement. Haemostasis was checked and an air leak test performed. The operative time was 220 minutes and estimated blood less than 20 cc. There was no intraoperative complication and the patient was discharged on post operative day 2. Conclusions The conversion of a gastric banding into sleeve gastrectomy is a valid therapeutic option in patient with no substantial weight loss although more data are needed to draw definitive conclusions. The robot is a useful option in redo surgery, allowing fine dissection.
