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Laparoscopic Reversal of Roux-en-Y Gastric Bypass
Following laparoscopic gastric by-pass, some patients develop dyspepsia which is uncontrolled by medical management. Surgical reversal of the Roux-en-Y procedure is then indicated. This video illustrates the significant steps that occur during the laparoscopic reversal of a previous laparoscopic antercolic-anterogastric Roux-en-Y gastric bypass. The patient is a 23 year old white female who had a laparoscopic gastric bypass performed in 2002. Despite losing weight over a few months, she had multiple visits and hospitalizations for management of her dyspepsia. Work-up showed no evidence of internal hernia or obstruction in either anastomosis. She elected to have her gastric bypass reversed laparoscopically. Extensive adhesions from her prior surgery occur between the liver, gastric pouch, Roux limb and gastric remnant. Adhesiolysis is required to mobilize the gastric pouch, gastric remnant and Roux limb. Following mobilization of the gastro-jejunostomy, gastroscopy inspects the anastomosis from within. No evidence of stenosis is seen. The gastro-jejunostomy is transected with a linear cutter. A small opening is made in the pouch and gastric remnant. The linear cutter is used to re-establish connection between the gastric pouch and gastric remnant. The anastomosis is closed using a spiral stitch. The Roux limb is transected proximal to the jejuno-jejunostomy and removed from the operative field following transaction of the Roux limb mesentery. The residual mesenteric defect is closed. Gastroscopy confirms the patency of the newly created anastomosis. Post-operatively the patient's dyspepsia symptoms have resolved. She has regained only 10 pounds after six months and feels that she can maintain her new weight. This video demonstrates that application of standard laparoscopic surgical techniques can successfully reverse a previous laparoscopic gastric bypass.
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