Background

The incidence of revisional bariatric surgery has increased as more patients develop long term complications from previously performed procedures. In this video we present a 65-year-old woman who developed life-limiting reflux, dysphagia, and unintentional weight loss after undergoing an unknown restrictive weight loss procedure approximately 30 years prior. Her preoperative evaluation confirmed a gastric obstruction with extrinsic compression of the mid body of the stomach, as well as significant esophageal dysmotility and reflux with very long-segment Barrett's esophagus. Patient was taken to operating room for anticipated conversion to Roux-en-Y gastric bypass (RYGB); however, intraoperative findings suggested previous gastric wrap procedure encircling the proximal stomach without gastric division. Dense adhesions prohibited creation of a gastric pouch, so the obstruction was relieved with a hand sewn gastrogastrostomy from the proximal to distal stomach. The patient recovered well after surgery and had complete alleviation of her symptoms. Several months later, however, she did require endoscopy with pneumatic dilation of an anastomotic stricture.