Demographics: · Patient MCS · Female · 35 years old · Weight—108 Kg · Height—1.59 m · BMI on revision—42.7 Kg/m2 · History of progressive obesity for the last 10 years · Open Sleeve Gastrectomy 6y before revision · BMI on first surgery—38.3 Kg/m2 · Nadir—29.5 Kg/m2 (1y after sleeve) · Started weight regain on the third year after surgery. Patient’s habits · No alcoholism or smoking · No physical activity. · Food habit—preference for snacks and junk food. · Tried some medications after weight regain (Sibutramine, Semaglutide). Current Comorbidities: · Hypertension in the last 2 years—Losartan 160 mg a day · Snoring · Moderate Hepatic Steatosis · GERD—pyrosis and dysphagia (validated questionnaire) developed after primary operation (“De Novo GERD”) · Previous open SG (6 y ago) · Previous open cholecystectomy (10 y ago) · One cesarean section Family History: · Obesity history—father’s family · Hypertension—father and mother · Gastric cancer—uncle from father’s family |
Preoperative workup § Preoperative UPPER DIGESTIVE ENDOSCOPY: · Erosive esophagitis grade A (LA classification) · Sleeve tube dilation, allowing endoscope retroflexion—approximately 5 cm wide · Mild antral gastritis · Histopathology—chronic inactive gastritis/H. pylori-negative § Preoperative UPPER RADIOLOGICAL GASTROINTESTINAL CONTRAST SERIES: · Gastroesophageal reflux · Dilated sleeve (more than 300 ml) (Figure 1) § Preoperative HRM: · Normal inferior esophageal sphincter pressure · Normal esophageal motility · Good esophageal functional reserve § Preoperative IMPEDANCE PHMETRY: · Pathological orthostatic acidic reflux · DeMeester Score—48.4 § Preoperative Abdominal ULTRASOUND: · Hepatic steatosis grade II · Cholecistectomy § Preoperative POLYSOMNOGRAPHY: · No sleep apnea § Preoperative LABORATORY TESTS: · B12 and Vitamin D deficiencies (supplemented) · Other laboratory tests were normal Other information: · Pre op workup ok, with due care; · Pre op multidisciplinary team counseling; · Proposed surgery—Re-Sleeve Gastrectomy with Roux-en-Y antrojejunal anastomosis; · Surgery performed on 03/02/22; · Surgical time—125 min; · Length of hospital stay—24 hours; · Uneventful postoperative recovery. |