Background

Due to prior popularity, Vertical banded gastroplasty anatomy is still encountered as well as its inherent complications of stomal stenosis, reflux, and regurgitation. Band removal may not suffice to relieve the obstruction. We describe a method of addressing such an obstruction using endoscopic guided trans gastric laparoscopy.

Methods

The patient is a 64-year-old female with history of open vertical banded gastroplasty approximately 30 years ago. She presented to bariatric clinic with both weight regain to BMI 40 and symptoms of reflux and post prandial emesis. Upper GI demonstrated no spontaneous or inducible gastroesophageal reflux, normal gastric emptying, and post-surgical changes of the stomach with hiatal hernia. There was also a narrow emptying of the proximal stomach. With medical weight loss, she had lost approximately 40 lbs and was a BMI of 32. However, given her GERD and emesis, a laparoscopic takedown of her VBG with possible conversion to RYGB was scheduled. Intraoperatively, extensive adhesions precluded safe laparoscopic gastric bypass. To address her symptoms, her band was removed. After band removal, upper endoscopy demonstrated no injury, but persistent small outlet of her proximal stomach. Using the endoscope to guide port placement and stapler position across the junction of the narrowed stomach and excluded stomach, a trans gastric gastro-gastrostomy was performed to widen the aperture of the proximal stomach. On post-operative follow-up, her reflux and emesis had resolved.

Conclusions

Upper endoscopy and trans-gastric laparoscopy can facilitate minimally invasive correction of post vertical banded gastroplasty complications.