Background

Roux-en-Y gastric bypass alters the gastrointestinal anatomy to make certain procedures not routinely feasible. One such concern is the difficulty in accessing the excluded remnant stomach to evaluate for bleeding or malignancy. This case report describes a 52 year old female who had a history of a laparoscopic gastric bypass with an incidental finding of a polypoid lesion in her remnant stomach. The patient was brought to the operating room for a laparoscopic assisted endoscopic resection of the lesion in her gastric remnant. Four 5mm trocars, a 15mm trocar to accomodate an endoscope, and a liver retractor were used to access the abdomen. A gastrotomy was made in the remnant stomach to insert the 15mm trocar. A gastroscope was placed through the trocar into the remnant stomach to visualize and remove the polypoid lesion from the fundus with a hot snare and endoscopic net. The lesion came back as a hyperplastic polyp and the patient was relieved with the minimally invasive method of diagnosis and resection of the lesion. In conclusion, in patients with altered anatomy such as a gastric bypass, identifying hybrid methods utilizing both laparoscopic and endoscopic techniques can be beneficial for minimally invasive identification, diagnosis, and treatment of lesions in difficult to reach locations with minimal morbidity.