Background

VBG may lead to complications over the years including gastric inlet obstruction from extrinsic compression due to the non adjustable gastric band and adhesions, dysphagia, GERD, and other problems. We present the case of a 63 y/o male with a history of open VBG in 1992 complicated by gastric inlet obstruction, dysphagia and severe GERD who underwent a preoperative work up with endoscopy and radiographic studies. Consensus from a multidisciplinary panel revealed that he was a good candidate for robotic conversion of the VBG anatomy to a Roux-en-Y gastric bypass (RYGB) with or without partial gastrectomy of the excluded portion of the stomach depending on blood supply and scar tissue. The robotic VBG was converted to a RYGB with partial gastrectomy of the proximal stomach due to poor perfusion and scar tissue evaluated intraoperatively with ICG fluorescence and endoscopy. The operation was performed successfully and the patient had a favorable hospital course and outpatient follow up at 3 years with upper endoscopy revealing no complications from the RYGB including an intact GJ anastomosis.Conversion of VBG to RYGB is feasible and safe, and has been well documented in the literature. A partial gastrectomy may be necessary in select cases due to poor perfusion of the excluded portion of the stomach, scar tissue formation, narrowing from gastric inlet obstruction or all of the above. The use of ICG fluorescence and intraoperative endoscopy is helpful to decide whether a partial gastrectomy is needed or not.