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Obesity Surgery

, Volume 26, Issue 1, pp 239–240 | Cite as

Laparoscopic Conversion of Sleeve Gastrectomy to Gastric Bypass for Super-Obesity (BMI ≥50 kg/m2) and Incisional Hernia: a Video Report

  • Jérémie ThereauxEmail author
  • Charles Roche
  • Jean-Pierre Bail
Video Submission

Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed procedure for morbid obesity in France. However, in case of de novo gastroesophageal reflux disease or of insufficient weight loss, LSG could be converted in rare cases to laparoscopic Roux-en-Y gastric bypass (LRYGB). In case of voluminous incisional hernia (IH) associated, this procedure could be technically challenging, especially in cases of super-obesity (body mass index (BMI) ≥50 kg/m2). Furthermore, IH should be repaired in order to avoid life-threatening post-operative small bowel obstruction.

Methods

We present the case of a 30-year-old woman (125 kg, 1.55 m) with a BMI of 52.1 kg/m2. She was referred to our tertiary care center for weight regain (Nadir 100 kg), 4 years after a LSG was performed for super-super obesity (BMI = 68.7 kg/m2). She also had a history of epigastric IH (single-incision LSG; diameter = 10 cm). The strategy adopted was to repair hernia with raphy. In case of hernia recurrence and of sustainable weight loss, use of prothetic mesh would be mandatory in the future.

Results

In this multimedia video, we present a step-by-step laparoscopic conversion of sleeve gastrectomy to LRYGB for super-obesity (BMI ≥50 kg/m2) and incisional hernia. Laparoscopic procedure included adhesiolysis, dissection, and resection of the low part of the remnant stomach, gastro-jejunal circular anastomosis, and closure of aponeurosis defect.

Conclusions

Incisional hernia and morbid obesity are often entangled problems. Revisional procedure of bariatric surgery with incisional hernia associated should be performed laparoscopically.

Keywords

Sleeve gastrectomy Gastric bypass Incisional hernia Morbid obesity 

Notes

Compliance with Ethical Standards

Ethics Approval and Consent to Participate

Informed consent was obtained from all individual participants included in the study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare that they have no competing interests.

Funding/Support

None

Previous Presentation

None

Supplementary material

ESM 1

In this multimedia video, we present a step-by-step laparoscopic conversion of sleeve gastrectomy to gastric bypass for super-obesity and incisional hernia (MP4 292 mb)

References

  1. 1.
    Gautier T, Sarcher T, Contival N, et al. Indications and mid-term results of conversion from sleeve gastrectomy to Roux-en-Y gastric bypass. Obes Surg. 2013;23(2):212–5. PubMed Epub 2012/09/25. eng.PubMedCrossRefGoogle Scholar
  2. 2.
    Thereaux J, Veyrie N, Barsamian C, et al. Similar postoperative safety between primary and revisional gastric bypass for failed gastric banding. JAMA surgery. 2014;149(8):780–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252(2):319–24. PubMed Epub 2010/07/14. eng.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Jérémie Thereaux
    • 1
    • 2
    Email author
  • Charles Roche
    • 1
  • Jean-Pierre Bail
    • 1
  1. 1.Department of Digestive SurgeryLa Cavale Blanche University HospitalBrestFrance
  2. 2.University of Bretagne Occidentale (UBO), EA 3878 (GETBO)BrestFrance

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