This video illustrates the use of laparoscopic techniques to resolve an acute gastric outlet obstruction after Laparoscopic Sleeve Gastrectomy (LSG).

We report a case of a thirty year old female six days status post LSG and removal of gastric banding for morbid obesity at an outside facility who presented to Cleveland Clinic Florida Emergency Room with new onset of complete outlet obstruction. Her symptoms were significant for dysphagia and persistent sialorrhea. Her extensive work up included a gastrografin swallow and sophagogastroduodenoscopy (EGD). The gastrografin series showed pooling of contrast in the distal esophagus and proximal stomach. The gastric lumen measured 5 cm in greatest diameter. The EGD showed a blind end in the proximal stomach with no erosions. The patient underwent a diagnostic laparoscopy. During the procedure a left subphrenic abscess was identified and drained. An intraoperative EGD showed a difficult passage of the scope into the mid portion of the sleeve. The capsule of the previously removed band was obstructing the outlet of the proximal portion of the sleeve. The capsule was dissected and removed partially. After the wrap was taken down, the suture used to reinforce the staple line was removed as well.

A new intraoperative EGD was performed showing free passage of the scope into the distal sleeve. The patient had an uneventful post-operative course.

When performing laparoscopic sleeve gastrectomy after LAGB, surgeons should pay special attention in removing the fundoplication and excising the fibrous capsule that surrounds the band in order to avoid proximal obstruction.