Background

This video demonstrates the robotic conversion of a one anastomosis gastric bypass to a Roux-en-Y gastric bypass for severe bile reflux. This patient is a 53 year old female with a history of obesity, gastroesophageal reflux, hypertension and anxiety who had previously undergone a laparoscopic one anastomosis gastric bypass in 2003 for weight loss. Over the course of 20 years, she lost over 100 pounds but developed severe bile reflux and had several hospitalizations for marginal ulcers. At the time of surgery, she was only tolerating a liquid diet due to her regurgitation and reflux. The patient's preoperative workup included an EGD which showed bile reflux and a possible gastrogastric (GG) fistula and a CT which showed a GG fistula proximal to the GJ staple line. Given her severe bile reflux and malnutrition, she elected to undergo robotic assisted conversion to Roux-en-Y anatomy. This procedure is presented and described as shown in the attached video and the patient was found to have a gastrogastric fistula which was taken down as part of the excluded stomach. The patient's postoperative course was uneventful and she was discharged home on postoperative day two tolerating a bariatric diet. She was seen in the clinic several weeks later with complete resolution of her bile reflux.