Learning process by video cases – our first laparoscopic conversion of VBG to CRnYGB including technical problems and complication management

The number of bariatric surgical procedures performed each year is growing worldwide. The techniques and our knowledge have changed and new indications for surgical metabolic procedures have appeared. Patients with type II diabetes, who might also be treated with surgical therapies in the future, exemplify that the number of patients in need of a metabolic procedure might grow enormously. We have learned already that not all of our procedures were well chosen and some do not fit the patients’ needs and behaviour. Some patients need to be re-operated to improve the outcome. Each department has its own re-operation rate and it is known to be as high as 20%. At our metabolic centre at Freiburg University, we see patients after bariatric surgery from various other departments. Sometimes we consider a re-operation when the patient reports complaints or a bad outcome. The development and improvement of diagnostic procedures and the establishment of guidelines for bariatric surgery is one of our main courses. The problem of indicating a re-operation and agreement with the patient about the medical approach are the most important matters. We would like to present the technical procedure and discuss problems and possible improvements of the following revisionary intervention: transformation of a vertical banded gastroplasty into a laparoscopic conventional Roux-en-Y gastric bypass. We will concentrate on the procedure technique and not discuss the indications for the gastric bypass procedure in general.