Gastric pouch sero-myotomy for persistent dysphagia after roux-en-Y gastric bypass: Video report

ABSTRACT: Highlights • Dysphagia after roux en Y gastric bypass can be related to problems at the pouch itself.• An initial step in the management should be trial of endoscopic dilalation.• Laparoscopic sero-myotomy is a valid and feasible option for the treatment of proximal gastric stricture.• Revisional operations after sleeve gastrectomy can cause this kind of strictures. Laparoscopic Sleeve Gastrectomy (LSG) is one of the most common bariatric operations done worldwide [1]. About 6.6% of the LSG is being converted to laparoscopic roux-en-Y gastric bypass (LRYGB), most commonly due to inadequate weight loss (65%) and severe reflux (26%) [2]. The most common late complications after LRYGB are dumping, small bowel obstruction, internal hernia, weight regain, marginal ulcer, strictures of the gastro-jejunostomy [3] and rarely proximal stricture at the gastric pouch as our presented case. Treatment options for such a case may start with endoscopic dilatation and if not succeeded it may warrant surgical intervention as shortening of the pouch and redo of the gastrojejunostomy proximal to the stricture or even total gastrectomy and esophago-jejunal anastomosis. Sero-myotomy of the gastric pouch can be done as the same technique which can be used in sero-myotomy of sleeved stomach with stricture [4] and spare resection of the pouch. This report aims to present a new option of surgical management for proximal stricture of the gastric pouch after LRYGB which to our knowledge was never published in the literature.

SUBMITTER: Abu Sneineh M 

PROVIDER: S-EPMC7744812 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature