Robotic revisional bariatric case. This 32-year-old lady had a laparoscopicbypass with silastic ring 10 years ago. In the last 6 years was vomiting almost every solid meal, and after vomiting, she always preferred doughy carbohydrates, such as pastries, pasta or cookies. When she came to me, she had gained almost all the weight she lost in the first 18 months and had lab tests showing anemia and low albumin. Endoscopy showed an enlarged gastric reservoir and difficult endoscope passage through the ring constriction, which was 2 cm above gastro-jejunal anastomosis. The proposed surgery was ring removal and resection of the gastric pouch side excess, including the gastro-jejunal anastomosis (gastric pouch trimming).
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