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Case Reports
. 2024 Mar 17;2024(3):rjae149.
doi: 10.1093/jscr/rjae149. eCollection 2024 Mar.

Revisional surgery for persistent dysphagia plus Roux Y gastric bypass robot-assisted in a patient with obesity. About a case

Santiago A Muñoz-Palomeque  1   2 , Máximo V Torres Guaicha  2   3 , Glenda Y Herrera Cevallos  2 , Tábata Lissette Tinoco Ortiz  2 , Amílcar O Herrera Cevallos  2
Affiliations
Case Reports

Revisional surgery for persistent dysphagia plus Roux Y gastric bypass robot-assisted in a patient with obesity. About a case

Santiago A Muñoz-Palomeque et al. J Surg Case Rep. .

Abstract

This case study presents a female patient with progressive dysphagia for solids, heartburn, and obesity that proved refractory to clinical management. Imagenological diagnosis revealed esophageal stenosis and achalasia. Furthermore, metabolic syndrome was established. We proposed intervention through esophagogastric reconstruction due to stenosis, revision of cardiomyotomy and robotic gastric bypass revealing scar tissue and fibrosis on the anterior aspect of the stomach resulting from prior fundoplication surgery. The patient underwent esophagogastric reconstruction due to adhesion bands which conditioned partial angulation of the gastroesophageal junction, cardiomyotomy revision, anterior and posterior hiatal plasty, and Roux Y Gastric Bypass assisted by a robot without complications. The intervention resulted in significant improvement in postoperative symptoms. This case highlights the importance of considering the probability of mechanical obstruction due to postsurgical adhesions in the initial evaluation of recurrent and persistent dysphagia, with surgical reintervention being the ideal option for resolution.

Keywords: bariatric surgery; deglutition disorders; fundoplication; obesity; robotic surgical procedures.

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Conflict of interest statement

We report that there is no conflict of interest.

Figures

Figure 1
Figure 1
Esophagogastroduodenal transit with barium contrast. (A) Enlarged esophagus; (B) area of stenosis; (C-E) fundoplication and hiatal hernia with stomach above the diaphragmatic domes; tertiary F waves.
Figure 2
Figure 2
Esophageal manometry with evidence of panpressurization (achalasia type II).
Figure 3
Figure 3
Transsurgical findings (hiatal hernia; anterior funfuplication; fibrosis of anterior cardiomyotomy; difficulty in passing the calibrating probe in the gastroesophageal junction; release of anterior fundoplication; fibrosis in anterior esophagogastric fundoplication).
Figure 4
Figure 4
Hiatoplasty (posterior hiatoplasty; passage of gauge probe without difficulty; anterior hiatoplasty; 4 cm of abdominal esophagus).
Figure 5
Figure 5
Preparation of Roux-en-Y Gastric Bypass (gastric pouch; gastrojejunal anastomosis; Petersen closure; biliopancreatic loop section; jejunojejunal anastomosis; biliopancreatic, common and alimentary loops).
Figure 6
Figure 6
Robot-assisted laparoscopic cholecystectomy.
Figure 7
Figure 7
Video links: (A) esophagram; (B) surgical procedure.
See this image and copyright information in PMC

References

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