Presenter: Maria C Mora, MD
Email: Maria C Mora, MD
Authors: Maria C Mora, MD; Karen A Diefenbach, MD; Marc P Michalsky, MD; Department of Pediatric Surgery, Nationwide Children's Hospital
With rising adolescent obesity, the use of adolescent bariatric surgery continues to increase. Although vertical sleeve gastrectomy (VSG) has been shown to be safe and effective, multiple short and long-term complications, including GERD can occur. We present a patient with a history of a laparoscopic VSG who presented with a one-year history of worsening dyspepsia and moderate weight regain (~11kg). UGI revealed concerns for chronic organoaxial gastric volvulus. Intraoperative findings included a dilated proximal pouch, extensive adhesions causing gastric volvulus, and distal gastric sleeve stenosis. After extensive lysis of adhesions, the sleeve was straightened and revised. Additionally, laparoscopically-guided endoscopic balloon dilation was performed addressing the gastric stenosis. Postoperatively the patient’s symptoms resolved. New onset and/or progressive GERD following VSG outside the immediate postoperative period should be evaluated. While conversion to a Roux-en-Y gastric bypass may be required, initial attempts to address gastric adhesions and/or chronic stenosis should be considered.