title: Laparoscopic revision of gastric bypass for gastrojejunal anastomotic stenosis and trans-mesocolic defect: video report.
abstract: OBJECTIVE
  Laparoscopic gastric bypass (LRYGB) is considered as the gold standard procedure for morbid obesity because of sustainable weight loss and coexisting conditions improvements (Sjostrom L et al. The New England journal of medicine 351(26):2683-93, 2004 [1]; Thereaux J et al. Surg Obesity Related Dis: Off J Am Soc Bariatric Surg, 2014 [2]). However, there are some concerns with the late risk of gastrojejunal anastomotic stenosis and of small bowel obstruction (Hamdan K et al. 98(10):1345-55, 2011 [3]).
  
  
  METHODS
  We present the case of a 46-year-old woman (70 kg, 1.67 m) with a body mass index (BMI) of 25.1 kg/m(2) who had undergone LRYGB, 3 years ago (initial BMI 45 kg/m(2)). She was referred to our tertiary care center for dysphagia and abdominal pain.
  
  
  RESULTS
  In this multimedia video, we present a step-by-step laparoscopic revision of a LRYGB for gastrojejunal anastomotic stenosis associated with trans-mesocolic defect. Procedure included dissection and resection of the strictured anastomosis, redo gastrojejunal circular anastomosis, and closure of the trans-mesocolic defect. No adverse outcomes occurred during the postoperative period.
  
  
  CONCLUSIONS
  Gastrojejunal anastomosis stenosis should be managed under laparoscopy. All abdominal surgery in patients with a history of LRYGB, especially with trans-mesocolic alimentary limb, should include inspection of potential meso-defect.
authors.affiliation: Department of General, Digestive and Metabolic Surgery, La Cavale Blanche University Hospital, Boulevard Tanguy-Prigent, 29200, Brest, France, jeremie.thereaux@hotmail.fr.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Thereaux
authors.forename: Charles
authors.initials: C
authors.lastname: Roche
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bail
mesh_terms: D015992:Body Mass Index; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D015390:Gastric Bypass / Q000379:methods; D006801:Humans; D007421:Intestine, Small / Q000601:surgery; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D014741:Video Recording; D015431:Weight Loss