Revision of failed sleeve gastrectomy to one anastomosis gastric Bypass with Transhiatal sleeve migration
EAES Academy. Almahfooz N. 07/05/22; 362964; P007
Dr. Nezar Almahfooz
Contributions
Contributions
Abstract
Present a case report of failed sleeve gastrectomy revised to one anastomosis gastric Bypass (OAGB), and the surgical management of coincidental sleeve migration, with short operative video.
Method
The patient is a young female who regain weight after laparoscopic sleeve gastrectomy (LSG). She was subjected to revisional OAGB, during which most of the sleeved stomach found intra-thoracic migrated with sliding hiatal hernia. The sleeved stomach dissected down with the esophagus and the crura repaired. The sleeved stomach divided with linear stapler and plicated with non-absorbable V-Loc TM suture over 36 French gastric bougie, and OAGB performed with Bypassed limb of 180 cm.
Results:
Her provisional weight was 110 kg, length 156 cm, and BMI 45.2 Obesity class III. She had dysphagia and hypoglycemia after the old sleeve. Weight reached 76 kg in 3 months, with EBWL (86.6%). Patient not attending further schedule follow up. Regain weight after 3 years to 85 kg, 90 kg after 4 years and finally reached 97 kg after 7 years. Decision made to do OAGB. The operation done with no peri or postoperative complications. She attends 3 clinic visits with no postoperative complaint. She lost 25 Kg EBW with a BMI of 29.6 in the last 3 months.
Conclusion:
Never to omit a step of patient preoperative protocol, especially upper endoscopy. Choose the proper bariatirc procedure, remember the possibility of intrathoracic migration of sleeved stomach. Re-think of LSG regarding the mid and long term follow up.
Method
The patient is a young female who regain weight after laparoscopic sleeve gastrectomy (LSG). She was subjected to revisional OAGB, during which most of the sleeved stomach found intra-thoracic migrated with sliding hiatal hernia. The sleeved stomach dissected down with the esophagus and the crura repaired. The sleeved stomach divided with linear stapler and plicated with non-absorbable V-Loc TM suture over 36 French gastric bougie, and OAGB performed with Bypassed limb of 180 cm.
Results:
Her provisional weight was 110 kg, length 156 cm, and BMI 45.2 Obesity class III. She had dysphagia and hypoglycemia after the old sleeve. Weight reached 76 kg in 3 months, with EBWL (86.6%). Patient not attending further schedule follow up. Regain weight after 3 years to 85 kg, 90 kg after 4 years and finally reached 97 kg after 7 years. Decision made to do OAGB. The operation done with no peri or postoperative complications. She attends 3 clinic visits with no postoperative complaint. She lost 25 Kg EBW with a BMI of 29.6 in the last 3 months.
Conclusion:
Never to omit a step of patient preoperative protocol, especially upper endoscopy. Choose the proper bariatirc procedure, remember the possibility of intrathoracic migration of sleeved stomach. Re-think of LSG regarding the mid and long term follow up.
Present a case report of failed sleeve gastrectomy revised to one anastomosis gastric Bypass (OAGB), and the surgical management of coincidental sleeve migration, with short operative video.
Method
The patient is a young female who regain weight after laparoscopic sleeve gastrectomy (LSG). She was subjected to revisional OAGB, during which most of the sleeved stomach found intra-thoracic migrated with sliding hiatal hernia. The sleeved stomach dissected down with the esophagus and the crura repaired. The sleeved stomach divided with linear stapler and plicated with non-absorbable V-Loc TM suture over 36 French gastric bougie, and OAGB performed with Bypassed limb of 180 cm.
Results:
Her provisional weight was 110 kg, length 156 cm, and BMI 45.2 Obesity class III. She had dysphagia and hypoglycemia after the old sleeve. Weight reached 76 kg in 3 months, with EBWL (86.6%). Patient not attending further schedule follow up. Regain weight after 3 years to 85 kg, 90 kg after 4 years and finally reached 97 kg after 7 years. Decision made to do OAGB. The operation done with no peri or postoperative complications. She attends 3 clinic visits with no postoperative complaint. She lost 25 Kg EBW with a BMI of 29.6 in the last 3 months.
Conclusion:
Never to omit a step of patient preoperative protocol, especially upper endoscopy. Choose the proper bariatirc procedure, remember the possibility of intrathoracic migration of sleeved stomach. Re-think of LSG regarding the mid and long term follow up.
Method
The patient is a young female who regain weight after laparoscopic sleeve gastrectomy (LSG). She was subjected to revisional OAGB, during which most of the sleeved stomach found intra-thoracic migrated with sliding hiatal hernia. The sleeved stomach dissected down with the esophagus and the crura repaired. The sleeved stomach divided with linear stapler and plicated with non-absorbable V-Loc TM suture over 36 French gastric bougie, and OAGB performed with Bypassed limb of 180 cm.
Results:
Her provisional weight was 110 kg, length 156 cm, and BMI 45.2 Obesity class III. She had dysphagia and hypoglycemia after the old sleeve. Weight reached 76 kg in 3 months, with EBWL (86.6%). Patient not attending further schedule follow up. Regain weight after 3 years to 85 kg, 90 kg after 4 years and finally reached 97 kg after 7 years. Decision made to do OAGB. The operation done with no peri or postoperative complications. She attends 3 clinic visits with no postoperative complaint. She lost 25 Kg EBW with a BMI of 29.6 in the last 3 months.
Conclusion:
Never to omit a step of patient preoperative protocol, especially upper endoscopy. Choose the proper bariatirc procedure, remember the possibility of intrathoracic migration of sleeved stomach. Re-think of LSG regarding the mid and long term follow up.
{{ help_message }}
{{filter}}