CASE REPORT

1. REDO BARIATRIC SURGERY
SLEEVE GASTRECTOMY TO MINI
GASTRIC BYPASS
D R A R I N D A M G H O S H
M S , M C H ( G A S T R O E N T E R O L O G Y S U R G E R Y )
S E N I O R C O N S U L T A N T
D R H A R P A L S I N G H
M S , D N B ( S U R G I C A L G A S T R O E N T E R O L O G Y )
A S S O C I A T E C O N S U L T A N T
D E P T T O F S U R G I C A L G A S T R O E N T E R O L O G Y, H P B &
G I O N C O L O G Y,
A D V A N C E D L A P A R O S C O P I C D I G E S T I V E & M E T A B O L I C
S U R G E R Y,
S AT G U R U PA R T A P S I N G H H O S P I T A L S , L U D H I A N A

2. CASE HISTORY
37 Yrs female with BMI of 62 (Weight 170 kg,
Height 166 cm) with Hypertension, COPD,
Sleep Apnoea Syndrome and osteoarthiritis.
She underwent Laparoscopic Sleeve Gastrectomy
in Feb 2011 after I week of optimization in
hospital.
She remained compliant to the DIET & FOLLOW
UP after surgery.

3. • A F T E R L A PA R O S C O P I C S L E E V E
G A S T R E C TO M Y, S H E G R A D U A L LY
R E D U C E D W E I G H T O F 5 - 7 K G E V E RY
M O N T H .
• H E R S L E E P A P N O E A & H Y P E RT E N S I O N
C U R E D .
• S H E C A M E D O W N TO W E I G H T O F 1 0 0 K G
W I T H B M I O F 3 6 K G / M 2 ( 7 0 % O F E W L )
A F T E R 2 Y R S O F S L E E V E .
• S H E R E G A I N E D W E I G H T TO 11 5 K G ( B M I
4 2 , 5 5 % O F E W L ) .
• T H U S PAT I E N T WA S P O S T E D F O R
CASE HISTORY

4. BEFORE AND AFTER 1ST STAGE

5. Counselling.
UGI Endoscopy.
Barium meal.
Nutritional evaluation.
PRE-OP

6. PORT POSITION
A - 10 mm Camera Port
B,C – 12 mm Working Ports
D – Liver Retractor
E – 5 mm Assistant Port

7. CONCLUSIONS
Super obese patients pose significant technical
and functional challenges.
Staged bariatric surgery is planned preoperatively
for a few patients.
Planned Staged Bariatric Surgery for
- Patients with very high BMI, High risk for
prolonged anaesthesia

8. LSG FOR SUPER OBESE PATIENTS
Mean overall follow-up time period was 73 months (38-95).
Mean excess weight loss (EWL) at 72, 84, and 96 months after LSG
was 52%, 43%, and 46%, respectively (overall EWL of 48%).
The mean BMI decreased from 66 kg/m(2) (43-90) to 46 kg/m(2) (22-73).
Seventy-seven percent of the diabetic patients showed improvement
or remission of the disease.
Eid GM et al.
Ann Surg. 2012 Aug;256(2):262-5.

9. CONCLUSIONS
Second stage (gastric bypass) is performed after
about 2 yrs as
- Significant weight-loss has occurred
- Liver has decreased in size
- Risk of anesthesia is much lower.
Though this approach involves two procedures,
we believe it a safe and effective strategy for
selected high-risk patients.