MODIFIED LAPAROSCOPIC SLEEVE GASTRECTOMY WITH EPIPHRENIC DIVERTICULECTOMY, HELLER MYOTOMY AND DOR FUNDOPLICATION

Classical gastrointestinal anastomoses have been made with sutures and/or metal staples, but have resulted in significant bleeding and leak rates. This video is demonstrating a compression anastomosis using magnets to achieve weight loss and remission of co-morbidities.
A linear magnet was delivered by flexible endoscopic catheter to a point 250 cm proximal to the ileocecal valve, and a second magnet was positioned in the first part of the duodenum; the bowel segments containing the magnets were apposed to initiate gradual incisionless compression. Laparoscopic assistance was used to obtain accurate bowel measurements, obviate tissue interposition, and close mesenteric defects.

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal neoplasms of the gastrointestinal tract with an annual incidence of 10-15 cases per million. Overall, they account for 0.1%-3.0% of all gastrointestinal tumors. GISTs take time to grow and become clinically expressed, therefore they are commonly an incidental finding. They appear throughout the gastrointestinal tract, however the most common site is the stomach followed by the small intestines, and rarely the rectum or esophagus. Gastroesophageal junction (GEJ) GISTs are extremely rare. We present a case of a unique resection, via DaVinci robot, of a GIST at the GEJ in a patient with type IV paraesophageal hernia.

We present a modification to a Laparoscopic Sleeve Gastrectomy (LSG) for the combined treatment of Class II obesity and an epiphrenic esophageal diverticulum in a patient with a relative contra-indication to a gastric bypass. The patient had a BMI of 39, ESRD on hemodialysis awaiting a Renal Transplant. A large epiphrenic diverticulum was found on endoscopy, and UGI Swallow confirmed a right posterolateral diverticulum, with preserved esophageal peristalsis. Technical highlights include hiatal and diverticulum dissection and diverticulectomy, Heller myotomy, Dor Fundoplication and hiatus closure. Lastly, the modified LSG preserving the part of the fundus used for the fundoplication.