Introduction: Bariatric surgery in patients with prior gastric surgery can be technically challenging. This video depicts the technique of laparoscopic sleeve gastrectomy in a patient who had undergone open paraesophageal hernia repair with fundoplication and anterior gastrostomy fixation. Her Body Mass Index at presentation was 47.

Methods: Using five abdominal ports, adhesiolysis was performed to expose the greater curvature of the stomach. The previous gastrostomy site was taken down. The entire greater curvature of the stomach was mobilized including the gastric fundus. A stapled sleeve gastrectomy was performed with the 34 French endoscope used as an obturator. The upper aspect of the staple-line was imbricated with a running continuous suture and the integrity of the sleeve was tested with air insufflation through the endoscope.

Results: The operative time was 2 hours 15 minutes. The length of hospital stay was 2 days. There were no postoperative complications. The patient denies any reflux symptoms and has lost 30 pounds at 4 weeks following surgery.

Conclusion: Laparoscopic sleeve gastrectomy in a patient who has previously undergone antireflux surgery is technically feasible and can lead to adequate initial weight loss. This video demonstrates some important fundamentals of reoperative bariatric surgery.