Aggarwal, R

Ahmed, A

Gomez, NF

Jamshidi, S

Markakis, C

Yeung, D

British Journal of Surgery

English

Spiral - Imperial College Digital Repository

Refashioning of gastrojejunal anastomosis and partial excision of gastricremnant in a patient presenting with haematemesis 3 years afterbanded gastric bypassBackground: Banded gastric bypass has been proposed as an alternativeto standard Roux-en-Y gastric bypass (RYGB) for more than 25 years. Itsproponents point to evidence of better intermediate term weight loss outcomesand decreased rates of weight regain, especially in the super-obese. However,complications unique to the technique namely band slippage and/or erosion canbe devastating and require expert management to ensure favourable outcomes.Methods: We present the case of a 34 year old female patient presenting withepisodes of epigastric pain and haematemesis 3 years after a banded gastricbypass procedure. She also complained of weight regain.A CT scan was unremarkable but endoscopy showed mesh erosion, stenosisof the gastrojejunal anastomosis and a large gastrogastric fistula, which wasalso demonstrated in a barium meal. A decision was made to revise thegastrojejunostomy.Results: The operation was completed laparoscopically. The gastrojejunostomyand eroded mesh were excised as was the part of the gastric remnantproximally to the gastrogastric fistula. The gastrojejunostomy was then refashionedand a hiatus hernia was also repaired.The patient had a postoperative course complicated by a lower respiratory tractinfection, but no surgical complications. She eventually made a full recovery andis asymptomatic 6 months after surgery.Conclusion: Banded gastric bypass is a valid modification of RYGB. Banderosion is a rare, serious complication, which can be managed safely andeffectively in a centre with experience in revisional bariatric surgery.

Refashioning of gastrojejunal anastomosis and partial excision of gastric remnant in a patient presenting with haematemesis 3 years after banded gastric bypass

http://spiral.imperial.ac.uk/bitstream/10044/1/50249/2/Refashioning.doc

Refashioning of gastrojejunal anastomosis and partial excision of gastric remnant in a patient presenting with haematemesis 3 years after banded gastric bypass

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