9-step magnetic assisted conversion from sleeve gastrectomy to roux-en-Y gastric bypass and hiatoplasty by single-port: Case report

Borjas Guillermo, Sánchez Nestor, Gonzalez Maria, Urdaneta Ali, Ramos Eduardo, Maldonado Andres, Borjas Guillermo, Sánchez Nestor, Gonzalez Maria, Urdaneta Ali, Ramos Eduardo, Maldonado Andres

Abstract

RYGB represents one of the best alternatives for weight loss in obese patients achieving a weight loss of up to 60% and a resolution of comorbidities of 70%. Revision surgery contemplates multiple techniques including the conversion from one surgical technique to another, structural changes to the primary technique, among others. GERD is now a long-term problem for patients who have undergone LGS. With this case report, we show the feasibility and viability of making this revisional procedure with magnetic assistance and single-port device. (ClinicalTrials.govNCT04945304). A 32-year-old female patient underwent a SG in September 2018 with a BMI of 30 Kg/m2 and no medical history of comorbidities. One year after the surgery the patient reached a BMI of 23,9 Kg/m2. In 2020 the multidisciplinary team made a diagnosis of intractable GERD and for that reason, it was decided to perform a conversion surgery to RYGB by single port technique and magnetic assistance. The purpose of this case report is to expose the viability to perform a revisional bariatric surgery with magnetic assistance acting like a second surgical assistant in the steps of the procedure and utilizing a single port device to make fewer before incisions, reduce postoperative pain, length of hospital stay and better cosmesis with a safety approach. We can demonstrate the technical feasibility and safety of performing a conversion surgery of LGS to RYGB and hiatoplasty with magnetic assistance by single port and also demonstrate that the magnetic system serves beyond the liver retraction.

Keywords: GERD; Gastric bypass; Magnetic surgery; Revisional surgery; Single port; Sleeve gastrectomy.

Conflict of interest statement

The authors declare they have no conflict of interest.

Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

Figures

Fig. 1
Fig. 1
IMANLAP® - Magnetic Surgical System. External neodymium magnet, grasper coupled with magnet, grasper with magnet plus silastic tube, and magnetic enhancer.
Fig. 2
Fig. 2
(A) Liver retraction with magnetic grasper attached; (B) Liver retraction with magnetic grasper attached to silastic tube.
Fig. 3
Fig. 3
Fundus retraction for dissection of the GE junction.
Fig. 4
Fig. 4
Gastroesophageal retraction by reference strip for hernioplasty.
Fig. 5
Fig. 5
Gastric body retraction by reference strip.
Fig. 6
Fig. 6
Transverse colon retraction.
Fig. 7
Fig. 7
Jejunojejunal anastomosis retraction assistance.
Fig. 8
Fig. 8
Intermesenteric closure.
Fig. 9
Fig. 9
Petersen's closure.
Fig. 10
Fig. 10
Limb retraction for the omega loop section.

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