[Minimally invasive robot-assisted gastric bypass after open Mason reduction gastroplasty]

The introduction of robot-assisted surgery in the treatment of morbidly obese patients has enlarged the armamentarium for surgeons involved in bariatric surgery. This article describes the experiences with a conversion surgery from a complicated open Mason gastroplasty to a Roux en Y gastric bypass using the da Vinci Xi robotic system.

A 29-year-old female patient underwent a Mason reduction gastroplasty by laparotomy in 1995 (body mass index BMI 53.2 kg/m²). The course was complicated with a revision due to abscess formation and subsequent secondary healing. In 1996 an open revision of the gastroplasty due to persisting gastroesophageal reflux disease and outlet stenosis with dilatation of the outlet and an open cholecystectomy for cholecystolithiasis were performed . Abdominoplasty was performed for skin flaps in 2001 after the patient had lost 68 kg in weight. The patient presented at our hospital because of insufficient weight reduction even with weight gain since 2001 and treatment-refractive gastroesophageal reflux with adhesion problems. Clinical examination revealed normal scar tissue formation with no indications for an incisional hernia. The BMI was 48.2 kg/m² with a body weight of 124 kg. The surgery was performed using a da Vinci Xi robotic system after access via a blunt dissection with the introduction of two trocars and adhesiolysis. The gastric pouch was created using Echelon 60 mm cartridges via an additional trocar. The gastroenterostomy was constructed with a 150 cm alimentary loop and a 60 cm biliodigestive loop resulting in a Roux en Y bypass. The operating time was 224 min.

The postoperative course was uneventful. Enteral nutrition was resumed on day 2 and the patient was discharged from the hospital 4 days postoperation.

This preliminary experience suggests that robotic revisional surgery can be performed safely even after complicated bariatric operations.