Background

We present a video of a conversion from sleeve gastrectomy to gastric bypass for gastroesophageal reflux disease poorly controlled under treatment (PPI). The case reported here is that of a 37-year-old woman weighing 56 kg, whose excessive weight loss was mainly due to poor food tolerance. The preoperative work-up showed stenosis of the gastric sleeve just below a small hiatal hernia. Reflux complicates 20% of sleeves and leads to a repeat operation in 2% of cases in the registries, which probably underestimates the number due to the lack of follow-up. Gastric bypass has demonstrated to be the option of choice in cases of gastric sleeve anomaly. The sarcopenia and fragility of the diaphragm pillars led us to use a biological prosthesis to reinforce the hiatus. The surgical procedure was performed with robotic assistance using Medtronic's HUGO platform.Post-operative recovery was straightforward, with an early return home, and improvement in food tolerance and reflux.