Sleeve to RNYGB

A 55-year-old male patient who underwent a Sleeve Gastrectomy in 2015. Currently, the patient presents with severe gastroesophageal reflux unresponsive to medical treatment. The patient is scheduled for revisional surgery, and conversion to RYGBP was proposed.

Clinical History:

• 55-year.old man

• Previous Sleeve Gastrectomy in 2015 with a BMI of 44 Kg/m² due to hepatomegaly secondary to NAFLD. At the time of Sleeve the patient had high blood pressure, diabetes mellitus with oral antidiabetics and sleep apnea 

• Currently the patient has a BMI of 30 Kg/m², no comorbidities and presents refractory gastroesophageal reflux refractory to medical treatment. The barium swallow also showed a paraesophageal hernia. An upper endoscopy showed no mucosal injury and, after functional testing , the patient has a De Meester score of 7.7 with no impairment in esophageal motility 

Technique Description:

1. We will perform a revisional RNYGB with hiatal hernia repair 

Procedure Steps:

1. Patient in supine position, open legs, and reverse Trendelenburg

2. Pneumoperitoneum creation

3. Laparoscopic port placement 

4. Dissection of the hiatal hernia and creation of the gastric pouch

5. Introduction of the anvil 

6. Section of great omentum and identification of jejunum for the anastomosis

7. Creation of the gastro-jejunal anastomosis (circular)

8. Creation of the jejuno-jejunal anastomosis (linear)

Training Objectives:

• Tips for revisional RNYGB after sleeve gastrectomy with hiatal hernia repair 

• Indications and patient selection