Long term complications in patients with Roux-en-Y gastric bypass (RYGB) include marginal ulcers, dumping syndrome, malnutrition, and obstruction. Gastric bypass reversal may be indicated in patients with intractable chronic morbidities that are refractory to conservative management and revisional surgery.
We present a video of a 59-year-old man with BMI 23 who had undergone laparoscopic RYGB 6 years ago. He developed multiple complications including internal hernia through Peterson’s space, intussusception of jejunojejunostomy, marginal ulcer with perforation, and chronic postprandial abdominal pain on high doses of narcotic pain medication managed by pain specialists. He was a candidate for robotic assisted reversal of Roux-en-Y gastric bypass.
We present a step-by-step method of robotic reversal of Roux-en-Y gastric bypass. The procedure began with hiatal hernia interrogation and repair. The gastric pouch was divided with a robotic stapler. An area suspicious for gastro-gastric fistula was isolated and divided with additional loads. The pouch was anastomosed with the bypassed portion of the stomach using linear robotic stapler in side-to-side fashion. After confirming adequate common channel length of 4.5 meters, the Roux limb was resected flush with the jejuno-jejunostomy. Indocyanine green was used to confirm viability of the anastomosed stomach and bowel. Postoperative course was uneventful and the patient was discharged on postoperative day 3 with significant improvement in his postprandial pain.
Robotic reversal of Roux-en-Y gastric bypass is technically feasible in select patients. The surgical technique is enhanced by superior three dimensional visualization and precise instrument control with multiple degrees of freedom.