Abstract
BackgroundGomez gastroplasty, which was developed in the 1970s as one of the gastric restrictive surgeries for severe obesity, partitions the stomach using a stapler from the lesser towards the greater curvature at the upper gastric body, leaving a small channel. This procedure is no longer performed due to poor outcomes, but surgeons can encounter late-onset complications even decades after the surgery. Here, we report a case of very late-onset stomal obstruction following Gomez gastroplasty which was successfully treated by revision surgery.Case presentationA 58-year-old man was referred to our institution with sudden-onset nausea and vomiting. He underwent weight loss surgery in the USA in 1979, but the details of the surgery were unclear. Esophagogastroduodenoscopy demonstrated a stoma at the greater curvature of the upper gastric body, and fluoroscopy showed retention of contrast medium in the fundus and poor outflow through the stoma. Abdominal computed tomography revealed a staple line partitioning the stomach. Considering these preoperative investigation findings and the period during which the surgery was performed, the patient was diagnosed with very late-onset stomal obstruction following Gomez gastroplasty. Supporting the preoperative diagnosis, the surgical findings revealed a staple line extending from the lesser towards the greater curvature of the upper gastric body and a channel reinforced by a running seromuscular suture on the greater curvature. Moreover, gastric torsion caused by the enlarged proximal gastric pouch was found. Re-gastroplasty involving wedge resection of the original channel was performed followed by construction of a new channel. Postoperative course was uneventful, and the patient no longer had symptoms of stomal obstruction after revision surgery.ConclusionsRe-gastroplasty was safe and feasible for very late-onset stomal obstruction following Gomez gastroplasty. Accurate preoperative diagnosis based on the patient’s interview and the investigation findings was important for surgical planning. A careful follow-up is required to prevent excessive weight regain after revision surgery.
Highlights
Gomez gastroplasty, which was developed in the 1970s as one of the gastric restrictive surgeries for severe obesity, partitions the stomach using a stapler from the lesser towards the greater curvature at the upper gastric body, leaving a small channel
Accurate preoperative diagnosis based on the patient’s interview and the investigation findings was important for surgical planning
We report a case of very late-onset stomal obstruction following Gomez gastroplasty that occurred approximately 40 years after the surgery
Summary
We successfully diagnosed complications of classical bariatric surgery performed decades ago despite extremely poor preoperative information, and treated the patient with revision surgery, thereby eliminating any further difficulties with eating. A careful follow-up is needed to prevent excessive weight regain. Competing interests The authors declare that they have no conflict of interest. Author details 1 Division of Upper GI, Department of Gastroenterological Surgery, Hyogo College of Medicine, 1‐1 Mukogawa‐cho, Nishinomiya, Hyogo 663‐8501, Japan. 2 Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, 1‐1 Mukogawa‐cho, Nishinomiya, Hyogo 663‐8501, Japan
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