Background

This video demonstrates the conversion of Billroth II with Braun enteroenterostomy anatomy to a Roux-en-Y gastric bypass for treatment of refractory reflux disease in a 59-year-old female. The patient had a remote history of a partial gastrectomy (antrectomy) for ulcerative disease. Her medical history consisted of hypertension, diabetes mellitus, hyperlipidemia, and gastroesophageal reflux. Her preoperative BMI was 30.4. Additional prior surgical history included two C-sections. On initial outpatient evaluation, she complained primarily of reflux symptoms. Outpatient workup consisting of upper endoscopy, upper GI, and NM gastric emptying study. The findings of this workup were consistent with esophageal dysmotility, small hiatal hernia, and gastroparesis.Given this constellation of symptoms and findings on workup, we discussed the possibility of converting her Billroth II with Braun enteroenterostomy anatomy to a Roux-en-Y gastric bypass. The patient successfully underwent the procedure and had an uneventful postoperative course. She has been seen most recently for her 8-month follow up evaluation, and was recovering very well at that time. She is no longer on proton pump inhibitors and has no complaints of reflux. Her BMI is 21 and she has increased energy.