Laparoscopic Conversion of a Vertical Banded Gastroplasty to a Sleeve Gastrectomy in a Morbidly Obese Patient with a Complicated Medical History

We present our technique for performing a laparoscopic conversion of vertical banded gastroplasty (VBG) to sleeve gastrectomy (SG) in a morbidly obese patient.

A 58-year-old female with history of hypertension, diabetes, and morbid obesity (BMI 41). She had initially undergone an open VBG (BMI 58) and cholecystectomy (2002) and subsequently underwent two laparotomies for small bowel obstructions and two open ventral hernia repairs. She initially presented for repair of her large ventral hernia; however, to minimize the risk of recurrence and complications during the abdominal wall reconstruction, she was referred first for surgical weight loss and scheduled for laparoscopic conversion of VBG to gastric bypass.

Initial access was obtained using an Optiview trocar and significant amount of adhesions were noted to the omentum, abdominal wall, stomach, and liver, including dense interloop adhesions precluding us from proceeding with a gastric bypass, our initial choice for conversion. Adhesions were taken down with a LigaSure device and sharp dissection. The previous vertical staple line was identified endoscopically. The banded area was narrowed, but intact, so the Marlex ring was divided to allow space for the new SG staple line. Stapler firings were oriented to divide the stomach parallel to the lesser curve and through the middle of the prior EEA opening, then up towards the Angle of His. Using Endo Stitch, the entire staple line was oversewn in a Lembert fashion. There was no evidence of narrowing on repeat endoscopy and leak test was negative.

This video demonstrates the feasibility and safety of one-step laparoscopic conversion of vertical banded gastroplasty to sleeve gastrectomy.