IPEG 2020 TOP ABSTRACT: Robotic-Assisted Sleeve Gastrectomy Revision and Endoscopic Treatment of Gastric Stenosis
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What the experts said
The utility of adolescent bariatric surgery has increased with the continued rise in adolescent obesity.
Although a safe procedure, various long term complications can arise from a sleeve gastrectomy.
The patient was a 23-year-old female who underwent a laparoscopic sleeve gastrectomy seven years ago.
She presented with complaints of epigastric pain and worsening reflux symptoms infrequently relieved with Pepcid.
The patient had gained 10 kg since her last yearly appointment.
Upper GI revealed that the proximal stomach had increased in volume compared to a previous upper GI.
The distal portion of the stomach had completely twisted upon itself, causing an organoaxial gastric volvulus.
An extensive amount of adhesions were noted upon entrance into the abdomen.
The omentum was wrapped over the stomach, obscuring the proximal portion as well as the hiatus.
A 36 French bougie was placed to assist with identification of the stomach but was unable to be passed beyond the upper portion of the pouch.
Dissection revealed both the left and the right crura and a small hiatal hernia.
The bougie was caught within the dilated pouch.
During dissection, the area of the chronically volvulized stomach was encountered, confirming the upper GI findings.
The dilated portion of the sleeve was resected using an endoGIA stapler with multiple reinforced black loads.
The hiatal hernia was repaired using two Ethibond sutures.
Endoscopic evaluation of the sleeve revealed an area of stenosis at the mid portion of the stomach.
Laparoscopically, no extrinsic compression of the area was noted to explain the endoscopic finding.
The stenotic area was able to be traversed with the endoscope only with laparoscopic assistance.
Balloon strictureplasty was performed with serial dilation using an endoscopic balloon up to 15 millimeters.
At completion, the waist initially noted laparoscopically was no longer as apparent, and the endoscope was easily passed.
The patient tolerated the procedure well without complications.
Post-operatively, the patient had resolution of her symptoms and is currently doing well.
Gastroesophageal reflux is a common postoperative complication from a sleeve gastrectomy.
The patient's reflux symptoms were likely worsened by the hiatal hernia, gastric stenosis, and gastric volvulus noted intraoperatively.
Although a gastric twist can cause a functional narrowing, this patient was also found to have a mechanical stenosis likely secondary to scarring.
The patient's symptoms were able to be treated without the need to convert to a Roux-en-Y gastric bypass.