Robotic Surgery in Conversion After Adjustable Gastric Banding

Abstract

Adjustable gastric banding has shown a high failure rate, with up to 60% of patients requiring conversion surgery. The most common indications include weight regain, associated comorbidities, local gastric band complications, reflux or dysphagia. The Roux-en-Y gastric bypass is one of the procedures that has demonstrated the best long-term results in resolving reflux and esophagitis. The removal of the gastric band and conversion to Roux-en-Y bypass can be a challenging surgical procedure due to the presence of adhesions, their dissection, and the identification of anatomical structures. The robotic-assisted approach has proven to be a valuable option in revisional bariatric surgery. We present the case of a 50-year-old woman with grade 3 obesity (BMI: 48.5 kg/m²), associated with obstructive sleep apnea syndrome (OSAS) and osteoarticular disease. She underwent laparoscopic adjustable gastric banding in 2006 (minimum BMI: 31.2 kg/m²) but experienced weight regain. After multidisciplinary evaluation, the patient was proposed for conversion surgery. She underwent gastric band removal and conversion to Roux-en-Y gastric bypass with a long gastric pouch, a 200 cm biliopancreatic limb, and a 100 cm alimentary limb, using robotic assistance. The procedure lasted 2 hours and 45 minutes. The postoperative period was uneventful, and the patient was discharged 24 hours after surgery. This case highlights the benefits of robotic-assisted surgery in revisional procedures, overcoming technical difficulties and enhancing the safety of the procedure.