Background

Bariatric surgery operations are made more complicated and challenging when previous gastric surgery has been done. Taking down a fundoplication during a bariatric operation can be one of the more challenging operations we do in bariatric surgery, especially when a recurrent hiatal hernia repair is done as well. The robotic platform affords stable 3-D vision, multi-arm control, enhanced dexterity and ergonomics that can improve the surgeon’s performance, reduce surgeon fatigue and increase surgeon stamina.

Methods

This is a 55 yo F s/p Laparoscopic Nissen Fundoplication with Hiatal Hernia Repair in 2015, with BMI of 48.8. EGD and Upper GI demonstrated a large recurrent and incarcerated hiatal hernia containing a significant portion of her stomach. A robotic platform was used to take down the fundoplication, reduce and repair the hiatal hernia, and perform a Roux-en-Y gastric bypass.

Results

The fundoplication was successfully taken down, the incarcerated recurrent hiatal hernia reduced and repaired, and the Roux-en-Y gastric bypass completed. The patient tolerated the procedure well and recovered well. She was readmitted briefly for shortness of breath and bilateral pleural effusions on POD 16.

Conclusions

A Roux-en-Y gastric bypass together with taking down a fundoplication and reducing a large incarcerated recurrent hiatal hernia is a complex and challenging bariatric operation. This video demonstrates technique as well as some of the advantages of a robotic platform in the performance of complex and challenging bariatric surgery.