A Simple Technique of Gastric Pouch Resizing for Inadequate Weight Loss After Roux-en-Y Gastric Bypass

Weight regain after Roux-en-Y gastric bypass (RYGB) is increasingly reported in the literature Debs et al. Surg Obes Relat Dis (2016). Laparoscopic resizing of the gastric pouch and the gastrojejunal anastomosis is an accepted surgical option Nguyen et al. (Obes Surg 25:928-34, 2015); Iannelli et al. (Surg Obes Relat Dis 9:260-7, 2013); Al-Bader et al. (Obes Surg 25:1103-8, 2015). The aim of this video is to present a simple technique of en bloc resection. We present the case of a 42-year-old woman with a BMI of 44 kg/m(2) who underwent laparoscopic RYGB in 2007. In 2015, she regained weight till reaching a BMI of 38 kg/m(2). 3D CT volumetry was performed that showed a pouch volume of 220 cm(3) and a gastrojejunal anastomosis diameter of 20 mm. There are often a lot of adherences between the gastric pouch and the residual stomach, which makes the dissection difficult and tedious, with the possibility to devascularize the residual stomach and lead to a gastric fistula from this residual stomach. We present in this video a simple technique of gastric pouch resizing that consists of en bloc resection of the gastric pouch, the residual stomach, and +/- the gastrojejunal anastomosis. We recommend this technique in case of severe adherences and inability to identify a cleavage plane between the excess gastric pouch and the resected stomach. Insufficient weight loss or weight regain after RYGBP is becoming more frequently encountered. As a result, revisional surgery will be more frequently performed. This simple technique allows an easier dissection across healthier tissues and is easier to perform in the presence of severe adherences between the gastric pouch and the residual stomach.