Sleeve gastrectomy can be used for the treatment of morbid obesity in super-obese or high risk patient, however weight loss may be limited by postoperative dilatation of the gastric pouch leading to weight regain. We describe the minimally invasive technique for conversion of a prior open sleeve gastrectomy complicated by splenectomy, cholecystectomy and hiatal hernia repair to a Roux-en-Y gastric bypass in a morbidly obese patient experiencing weight regain.

Using five working abdominal ports extensive adhesiolysis was performed. The stomach was mobilized and transected leaving a 50cc pouch. The Roux-en-Y reconstruction was then performed.

The operative time was 120 minutes. There were no postoperative complications. Patient was started on an oral diet and discharged on postoperative day 4. Minimally invasive conversion of an open sleeve gastrectomy to Roux-en-Y gastric bypass is technically feasible. This video shows some important fundamentals of revisional surgery.