Background

Introduction: From a literature search of PUBMED there is no prior report of a gastric sleeve being performed on a patient with history of pancreaticoduodenectomy. We present a method to perform a robotic assisted laparoscopic sleeve gastrectomy in a patient with prior pylorus sparing pancreaticoduodenectomy. The patient is a 40 year old female with a BMI of 42.05 with prior pylorus sparing pancreaticoduodenectomy with an antecolic duodenojejunostomy for a T3N0 pancreatic head neuroendocrine tumor. Video Description: Intrabdominal access is obtained via 5mm Optiview port placed in the right lateral abdomen. Numerous adhesions are encountered with omental adhesions in the lower mid-abdomen and transverse colon adhesions to the upper abdomen. Adhesions are taken down allowing placement of a 8 mm left lateral port, 12 mm right periumbilical port, and 8 mm left periumbilical port. The Davinci robot is docked. Adhesiolysis is continued until access is obtained to the upper abdomen and the space above the colon and duodenojejunostomy. An endoscopy is performed identifying the duodenojejunostomy. 6 cm from the pylorus is measured out and a vessel sealer is used to take down the greater curve attachments. The endoscope is replaced with a 40 Fr bougie. A blue load in a sureform stapler is used to hug the bougie and begin the sleeve gastrectomy. Several white loads are subsequently used to transect the stomach until the angle of his is reached. Postoperatively the patient does well. She tolerates a regular diet and endorses a 32 lb weight loss on postoperative day 42.