The ideal weight-loss procedure for the obese, re-operative anti-reflux patientis controversial. Previous authors have suggested conversion to Roux-Y gastric bypass (RGB) as the operation of choice. We propose the laparoscopic sleeve gastrectomy (LSG) is a simpler, safer alternative.

Our patient is a 47 year old female, BMI 36.5, who met NIH criteria for weight-loss surgery. Twenty-three years prior, she underwent an open Nissen fundoplication and cholecystectomy for GERD with good initial control. With increasing GERD symptoms and obesity co-morbidities, she was offered conversion to LSG for weight-loss.

Laparoscopic Nissen takedown and LSG were performed in 204 minutes. A stapled 60 ml gastric tube was created sizing a 32 Fr bougie against the lesser curve of the stomach. EBL was 150 mls. A scheduled UGI on POD#1 revealed no leak. The patient was discharged home on POD#2 tolerating a bariatric liquid diet. Weight loss after 6 months was 66 lbs, BMI 26.8. Her reflux has resolved.

Conversion to LSG is a safe, effective alternative to RGB in the obese patientwith previous anti-reflux surgery. Not requiring substantial gastric and small bowel mobilization or anastomoses in the re-operative field, LSG may prove to be the safer, more desirable, procedure.