Background

Patient is a 42 year old female with a past medical history of hypertension, hyperlipidemia and morbid obesity (BMI 50), who desired weight loss surgery. Preoperatively, an upper endoscopy was performed, revealing mild gastritis. Antral biopsies were performed, which came back positive for autoimmune atrophic gastritis on the pathology report. A discussion detailing the increased risk of the development of gastric cancers in autoimmune gastritis was held with the patient. After this discussion, the patient still desired a bypass. Therefore, the decision was made to perform a Roux-en-Y gastric bypass with remnant gastrectomy due to the difficulty of accessing the remnant stomach if the patient required continuous endoscopic surveillance. This video demonstrates a Roux-en-Y gastric bypass with a two layered hand-sewn gastrojejunostomy as well as the dissection and key technical steps for performing a remnant gastrectomy. The patient's post-operative course was uneventful and she was discharged on post-op day two. Her most recent follow up was at 24 months where she was doing well and had significant weight loss (BMI 33).