Background

We present the case of a 40 year old woman who underwent endoscopic sleeve gastrectomy at a different hospital for BMI 55 and obstructive sleep apnea complicated by a leak needing stenting and EGD with endoscopic suturing. She had reflux as well as postoperative weight gain. She was referred to the bariatric surgery service for evaluation. Preoperatively an EGD was performed revealing sutures, metal fasteners, and a 3cm hiatal hernia. Suture and t fastener were removed.Intraoperatively, the hiatal hernia was reduced and cruroplasty performed. Peri-gastric tunnel was created and tucked into the esophagus. An Endo GIA stapler was used to divide the stomach and omega loop of jejunum was brought up and a two layered gastrojejunostomy was created. The jejunum was then divided and an anastomosis performed to create roux limb and biliopancreatic limb. Post operative upper GI showed normal motility without stricture. At one month follow-up, patient had lost 13% excess body weight and her reflux symptoms have resolved. This case highlights the complex decision making involved in the care of a patient with complications arising from endoscopic sleeve gastrectomy and the considerations when revising such advanced endoscopic interventions.