Conversion of a Failed Vertical Banded Gastroplasty to One-Anastomosis Gastric Bypass in a Case with Gastro-gastric Fistula and Mesh Complication: A Multimedia Article

Abstract

A 56-year-old female presented with recurrent weight gain (RWG) and vomiting, 10 years after open VBG. Imaging and endoscopy revealed an anatomically distorted pouch, two staple line dehiscences, and a gastro-gastric fistula (GGF). Multiple revisional options were evaluated. Due to the presence of mesh and anatomical limitations, a decision was made to perform a one-anastomosis gastric bypass (OAGB) below the mesh, guided by a calibration tube passed through the area of disruption. Laparoscopic OAGB was performed with a 150-cm biliary limb and a 3-cm gastrojejunostomy. Intraoperative leak testing was negative. The patient had an uneventful recovery and was discharged on postoperative day 3. At 18-month follow-up, she achieved a weight of 74 kg (body mass index (BMI) 25.4 kg/m2), with complete symptom resolution and normal laboratory parameters.