Laparoscopic Revisional Gastric Bypass after open bariatric surgeries

1Surgery Department, Riyadh Military Hospital, Riyadh, Saudi Arabia

Haider Alshurafa1

Objective: To confirm the feasibility of the laparoscopic revisional gastric bypass after open failed
bariatric operations.Method: Retrospective review of all patients who have underwent revisional gastricbypass after open bariatric operations, all of these operations were done by the author.Results: The
were 56 patients over 5 years had revisional gastric bypass, 28 patients had previous open bariatric
operations. They form 6% of all the patients who have underwent laparoscopic gastric bypass by the author,
50% of these were post open bariatric surgeries. Only 4 patients had converted to open procedures, one
was started open and it was at the early of the author experience. 55 patients were started laparoscopic
and 3 were converted to open due to sever adhesions, they were also in the early experience. Out of fpost open bariatric operations, 21 patients have failure to lose weight and/or weight regain, 4 patients
have complications, and 3 patients have both failure to lose weight and complications. There were nomortality and no leakage. Only one patient have needed laparoscopic re-exploration due to twisting at
the jejuno-jejunal anastomosis three days post operation. There were only 8% minor complications, likewound infections, self controlled bleeding.Conclusion: Laparoscopic revisional gastric bypass isfeasible after open bariatric surgeries but these types of operations have high surgical skills demandand carry higher risks for the complications.

Revisional endoscopic surgery after gastric bypass

1Bariatric surgery, University Hospital Brugmann , Brussels , Belgium 2monika lybeer

alex M.F. heylen1,monika E.B. Lybeer1

The importance of the restrictive component of gastric bypass procedures is well recognized.Dilatationof the pouch-outlet , the pouch volume itself
bypassare three factors

and the presence of a gastro-gastric fistula after gastricresponsible for substantial weight gain, volume per meal increases, rapid

pouch emptying invites for binge-eating. Revisional surgery should be avoided by doing the first operation
as it should , but if necessary it is often difficult and prone to at least double the morbidity of theprimary operation and with unknown long term results. Narrowing the stoma size , closure of a gastrogastricfistulaendoscopically with the OTSC clip is a very effective and safe alternative.Presentation of astudy on 118 patientsendoscopically treated either for stoma dilatation or gastrogastric fistula

between october 2008 and june 2009

Validity of sleeve gastrectomy for band failures

1

Al Taie center for laparoscopic and Obesity surgery,Dubai,UAE

Abdulsalam S. Al Taie1

Introduction:

Gastric banding is the one of the main restrictive procedures among the bariatric

operation. sleeve gastrectomy proved to be more than just a restrictive operation,andproved to be

successful for patients who had failed to lose their weight with banding.Patients and Method: 52 patientswere included in this study. All had their bands done More than a year earlier.
Mean age 28( 18 -52).31 female and 21 male. theymean BMI

41 (38-49).

were with no significant co-morbidities. All had sleeve

gastrectomy done along with the removal of the band at the same session . The band was removed, thetunneling sutures is removed and the fundus was stretched back to its original anatomy after the excisionof the peri gastric fibrous ring at the band site. Then sleeve gastrectomy is performed in the usual
way using endo GIA stapling devise and we suture the proximal staple line with 2/0 vicryl . Theupfollow

ranges from 1 to 4 years (19)(14)(11) and (8) patients respectively.Results: There was no major

morbidity( Gastric leakage) ,no mortality, 3 wound infections, 1 chest infection. No convertions tolaparotomy. Mean hospital stay 3 days(2-4). At the end of the first year following the operation all
had significant weight loss 35-45% of the EBW. At 2 year 33 patients have lost 55% of the EBW. By thethird year 19 patients had 55% EBW loss,At 4 years 8 patients lost 65% of their EBW.Conclusion: Sleeve
gastrectomy can be regarded as a salvage procedure for band failure patients and sure it is more thana restrictive procedure , it is a valid metabolic operation and may be comparable to Gastric bypass forpatients with failed bands.

Laparoscopic pouch resizing, new gastro-jejunal anastomosis and strictly cardial adjustable band
placement for failed Gastric Bypass

1General, Obesity, Endocrine and Oncologic Unit Centre Hospitalier de Dinant, Dinant , Belgium

Jean-Philippe M.m.K. Magema1,Virgil_A Dimbezel1,Isabelle_M Kellner1,Gael G Jacquemin1,Jean-P Boeur1

Bariatric surgery has developed and provides a great quantity of different procedures, some moreinnovative and still undergoing careful evaluation.We now face a growing number of long-term "failed"patients. For the RYGBP, literature usually rates from 20 to 35 %.Proximal pouch dilatation is a wellknown cause.We here describe a new approach: Laparoscopic pouch resizing, new gastro-jejunal anastomosisand strictly cardial adjustable band placement.To our knowledge this procedure has not been reported
in literature yet.A

58 years woman who underwent a LRYGBP surgery 3.5 years priorly, with primarily

good weight loss and resolution of type 2 diabetes, regained weightand thus underwent this procedure.The

surgical technique, documented with patient s data, XR pictures and per-operative shootings, isdescribed.No early complications were reported. The patient is doing very well at 4 weeks follow-up.We
tend to gather more patients on more long term follow-up to assess scientific conclusions for what could
be an interesting "second chance" new procedure for those failed cases.

Laparoscopic Band Revision to bypass:A Single Stage procedure1

Department of Bariatric and Metabolic Surgery,Gem Hospital and Research Centre,Coimbatore,India

Praveen Raj1,Palanivelu Chinnusamy1

Background:As the number of Bariatric Surgeries increased, so did the number of Revisional Surgeries
too. As per the recent meta-analysis by Buchwald et al, the number of Bariatric procedures performedin Asia in 2008
Indians

is the least .As the number of procedures being done is on the rise , we Asians including

might have to start facing more number of Revisional Surgeries too.Video:In this High Definition

Video , we demonstrate one of our cases of a Laparoscopic Band Revision to bypass as a Single Stage
procedure for weight Recidivism in a 35 yr old Female.Steps:-The adhesions over the band was released,
the band was cut and removed along with the pseudo capsule after dividing the gastro-gastric sutures.-Thegastric pouch was created using linear staplers in the standard fashion and the anastamosis was doneusing standard limb lengths, 75cm biliopancreatic limb and 75cm alimentary limb.-The gastrojejunostomy
is being performed in antecolic fashion using linear staplers.-Mesenteric defects were closed as well.

Laparoscopic Revisional Roux en Y Gastric Bypass for Weight Recidivisim

1

Department of Bariatric and Metabolic Surgery,Gem Hospital and Research Centre,Coimbatore,India

Praveen Raj1,Palanivelu Chinnusamy1

Background:As the number of Bariatric Surgeries increased, so did the number of Revisional Surgeries.
As per the recent meta-analysis by Buchwald et al, the number of Bariatric procedures performed in Asia
in 2008is the least .As the number of procedures being done is on the rise , we Asians including Indiansmight have to start facing more number of Revisional Surgeries too. Roux en Gastric bypass is one procedure
with very few revisional alternatives.Video:In this High Definition video, we demonstrate a Revisional
Bypass for weight recividism , wherein the the large gastro-jejunal stoma was revised in a 22 yr oldfemale .The patient who on evaluation for weight recidivism was found to have a larger stoma than usualand hence had increased capacity to eat. Hence was taken for stomal revision by narrowing the stoma using
a linear staplers application over a 36 F bougie and excising a gastrojejunal sleeve thus narrowing thestoma. The patient is losing acceptable amount of weight postoperatively.

Bariatric Revision Surgeries
Sanjay Borude
Abstract
Introduction
REAL complications associated with the operation and SIDE EFFECTS associated with thealteration in the upper GI anatomy.
The preioperative mortality of bariatric surgery was 0% and worldwide is usually associatedwith
1. Anastomotic leaks with peritonitis (75%) or
2. Pulmonary embolism (25%).
MethodREVISION INDICATIONS - GASTRIC BAND SURGERY· Port Site Complications after GB· Port Leakage- Cracking of the kink-resistant tubing or Tube Disconnection· Port Site Pain
· Port Dislodging or Flipping· Bulging of the Port through the Skin
· Infection of the Fluid within the Band
· Infection of the Port – Either at Surgery or Band Fill or Erosion
REVISION INDICATIONS - SLEEVE GASTRECTOMY SURGERY· Pouch Enlargement· Staple Line Dehiscence· Stomach Perforation· Stricture· Volvulus
REVISION INDICATIONS - GASTRIC BYPASS SURGERY· Pouch Enlargement· Staple Line Dehiscence· Stricture· Perforation· Infection· Psychological· Associated DiseaseAnalysis
Early postoperative complications·

PULMONARY EMBOLISM is the leading cause (1% to 2%) of perioperative death in bariatric
surgical patients.
The incidence of MAJOR WOUND INFECTION after gastric bypass ranges from 1% to 3%.
GASTROINTESTINAL BLEEDING within the 30-day perioperative interval may have a varietyof causes.
Small bowel obstruction (SBO) ranges from 1% to 2%ACUTE GASTRIC DISTENTION

The incidence of intraoperative complications in our series 1.4%
Late complications




Incisional hernia (most common)
Symptomatic gallbladder disease ranges from 3% to 30%.
Vomiting.
The incidence of Late Staple-line breakdown varies from 2% to 23%.
Gastro-gastric fistulae after transsection ranges from 1% to 2%.
The incidence of marginal ulcer after RYGB ranges from 3% to 10%.

Conclusion
Complications following Bariatric Surgeries can be reduced to negligible if great care istaken Pre-Intra-and Post-operative period.