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[Conversion to laparoscopic Roux-en-Y gastric bypass after vertical banded gastroplasty. A case report]
Mucio Moreno-Portillo1, Freddy Pereira-Graterol, Francisco Javier Magos
1Hospital General "Dr. Manuel Gea González," División de Cirugía Endoscópica, sexto piso, Oficina de Invasión Mínima, Calzada de Tlalpan 4800, Col Toriello Guerra, Tlalpan 14000 México D.F., México. pfreddy@telcel.net.ve
Background:
Vertical banded gastroplasty (VBG) is sometimes associated with gastroesophageal reflux disease (GERD) and long-time failure in weight loss. This situation is a problem; one therapeutic option is a Roux-en-Y gastric bypass (RYGBP).
Objective:
To analyze the perspective of laparoscopic surgical treatment in a patient with persistent GERD after traditional bariatric surgery for morbid obesity management.
Case Report:
A 48-year-old woman with morbid obesity, body mass index (BMI) of 46 kg/m(2), and high blood pressure underwent VBG (open surgery, Mason's technique) in 1996 and decreased her BMI to 32 kg/m(2). Six years after initial surgery, she developed severe GERD resistant to medical treatment (omeprazol 80 mg/day) that was confirmed by 24-h esophageal pH monitoring (48 DeMeester normal) and esophageal manometry (low esophageal sphincter pressure) 5 mmHg). During these years, she increased BMI from 32 kg/m(2) to 40 kg/m(2). Laparoscopic conversion to RYGBP was performed.
Results:
Postoperative evolution was satisfactory with disappearance of GERD. Control 24-h esophageal pH monitoring reported 4 DeMeester normal. At 12-month follow-up, she decreased BMI to 27 kg/m(2).
Conclusions:
Laparoscopic reoperative RYGBP is a viable surgical option in GERD treatment and obesity control.