Background

This is a video compilation of two Robotic Assisted (RA-) cases involving conversion from adjustable gastric band to roux-en-Y gastric bypass in one and two stages depicting difficult dissection and takedown of gastro-gastric imbrication requiring a partial gastrectomy because of chronic slippage and large hiatal hernia. Case 1: The first patient is a 45 year old female with a laparoscopic adjustable gastric band (LAGB) placed in 2008 who developed intermittent nausea, dysphagia and weight recurrence secondary to chronic band slippage. She underwent band removal and conversion to roux-en-Y gastric bypass in one stage.Case 2: The second patient is a 59 year old female with LAGB in 2010 who presented with severe reflux and dysphagia. She underwent removal of the LAGB in 8/2021. She did well for a few months but unfortunately presented again with refractory reflux and weight recurrence, workup revealed a large hiatal hernia. She underwent roux-en-Y gastric bypass with hiatal hernia repair on 12/2023. This video shows another difficult dissection because of the large hiatal hernia and migration of gastro-gastric imbrication into the thoracic cavity.