This video illustrates two challenging conversions to laparoscopic Roux-en-Y gastric bypass:

Case #1: 57 year old male with BMI of 62 kg/m² and a weight of 480 pounds who underwent an undetermined bariatric surgery approximately 20 years ago. His weight loss was significant but lasted only 3 years. An oral contrast study done at our institution was compatible with a disrupted undivided gastric partition with Billroth II reconstruction. The video illustrates the surgical steps required to convert this patient to a laparoscopic Roux-en-Y gastric bypass: taking down the Billroth II, performing gastrogastrostomy to reverse the previous gastric partition, and creating a new small gastric pouch measuring about 20cc.

Case #2: 49 year old woman with a BMI of 43 kg/m² who underwent Nissen fundoplication for GERD. After two years from this procedure, she was referred for redo Nissen because of recurrent GERD symptoms and endoscopic evidence of disrupted fundoplication and hiatal hernia. Considered her high BMI, the patient was advised to undergo laparoscopic Roux-en-Y gastric bypass. The video illustrates all the surgical steps required to convert this patient to a laparoscopic Roux-en-Y gastric bypass: taking down of the Nissen fundoplication, unwrapping the fundoplication and creating the gastric pouch.