Antonio Iannelli1,2,3, Lionel Sebastianelli4,5, Sébastien Frey4,5, Anne-Sophie Schneck6, Niccolo' Petrucciani4,5,7. 1. Université Côte d'Azur, Nice, France. iannelli.a@chu-nice.fr. 2. Digestive Surgery and Liver Transplantation Unit, Centre Hospitalier Universitaire de Nice, Archet 2 Hospital, 151 Route Saint Antoine de Ginestière, BP 3079, Nice Cedex 3, France. iannelli.a@chu-nice.fr. 3. Inserm, U1065, Team 8 "Hepatic Complications of Obesity and Alcohol", Nice, France. iannelli.a@chu-nice.fr. 4. Université Côte d'Azur, Nice, France. 5. Digestive Surgery and Liver Transplantation Unit, Centre Hospitalier Universitaire de Nice, Archet 2 Hospital, 151 Route Saint Antoine de Ginestière, BP 3079, Nice Cedex 3, France. 6. Digestive Surgery Unit, Centre Hospitalier Universitaire de Guadeloupe, Pointe-à-Pitre, Guadeloupe. 7. Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
Abstract
BACKGROUND: Laparoscopic gastric banding (LGB) is associated with high rate of failure (Stenard and Iannelli. World J Gastroenterol; 21:10348-57 2015, Lazzati et al. Ann Surg. 2016). In case of failure, conversion to Roux-en-Y gastric bypass (RYGB) is preferred (Noel et al. Surg Obes Relat Dis;10:1116-22; 2014, Schneck et al. Surg Obes Relat Dis;12:840-8, 2016). METHODS: We present the case of a 63-year-old woman with a BMI of 57 kg/m2 who underwent LGB in 2011. In 2015, she consulted for intolerance of the banding and weight regain, with a BMI of 52. The gastric band was removed, and 6 months later conversion to RYGB was performed. RESULTS: The main technical problem of conversion of LGB to RYGB is where to staple the stomach, either below or above the band-related scarring tissue. Stapling below the band in a fresh non-scarring area often results in the creation of a large pouch; furthermore, the vertical part of the pouch stapling is done on scarring tissue, with a risk of leak. Stapling above the band leaves a very small part of stomach and may be technically challenging. The present video shows the conversion of LGB to RYGB. The hiatal region is dissected, and a small pouch stapling above the band-related scarring tissue is fashioned. An RYGB with a 150-cm alimentary limb and a 50-cm biliopancreatic limb is confectioned. CONCLUSIONS: For conversion of LGB to RYGB, a small gastric pouch above the gastric band scar tissue is confectioned, after dissection of the hiatal region and abdominal esophagus. The small pouch ensures the restriction, and all the stapling and suturing are done on healthy, fresh tissue.
BACKGROUND: Laparoscopic gastric banding (LGB) is associated with high rate of failure (Stenard and Iannelli. World J Gastroenterol; 21:10348-57 2015, Lazzati et al. Ann Surg. 2016). In case of failure, conversion to Roux-en-Y gastric bypass (RYGB) is preferred (Noel et al. Surg Obes Relat Dis;10:1116-22; 2014, Schneck et al. Surg Obes Relat Dis;12:840-8, 2016). METHODS: We present the case of a 63-year-old woman with a BMI of 57 kg/m2 who underwent LGB in 2011. In 2015, she consulted for intolerance of the banding and weight regain, with a BMI of 52. The gastric band was removed, and 6 months later conversion to RYGB was performed. RESULTS: The main technical problem of conversion of LGB to RYGB is where to staple the stomach, either below or above the band-related scarring tissue. Stapling below the band in a fresh non-scarring area often results in the creation of a large pouch; furthermore, the vertical part of the pouch stapling is done on scarring tissue, with a risk of leak. Stapling above the band leaves a very small part of stomach and may be technically challenging. The present video shows the conversion of LGB to RYGB. The hiatal region is dissected, and a small pouch stapling above the band-related scarring tissue is fashioned. An RYGB with a 150-cm alimentary limb and a 50-cm biliopancreatic limb is confectioned. CONCLUSIONS: For conversion of LGB to RYGB, a small gastric pouch above the gastric band scar tissue is confectioned, after dissection of the hiatal region and abdominal esophagus. The small pouch ensures the restriction, and all the stapling and suturing are done on healthy, fresh tissue.
Authors: Andrea Lazzati; Marie De Antonio; Luca Paolino; Francesco Martini; Daniel Azoulay; Antonio Iannelli; Sandrine Katsahian Journal: Ann Surg Date: 2017-03 Impact factor: 12.969
Authors: Anne-Sophie Schneck; Andrea Lazzati; Etienne Audureau; François Hemery; Jean Gugenheim; Daniel Azoulay; Antonio Iannelli Journal: Surg Obes Relat Dis Date: 2015-10-21 Impact factor: 4.734
Authors: Patrick Noel; Anne-Sophie Schneck; Marius Nedelcu; Ji-Wann Lee; Jean Gugenheim; Michel Gagner; Antonio Iannelli Journal: Surg Obes Relat Dis Date: 2014-03-15 Impact factor: 4.734