Background

A 67-year-old woman underwent two prior bariatric operations, the latter in 1982 believed to be a horizontal mesh band gastroplasty. She had chronic history of nausea, vomiting and esophagitis, and was transferred acutely to our tertiary referral bariatric center with worsening symptoms of gastric obstruction. Endoscopy showed an hourglass stomach with a waist-like stricture in the mid-stomach. This stricture was dilated to 18 mm, but her symptoms did not improve and an upper GI study showed significant esophageal and proximal gastric dilation with a persistent mid-body narrowing. A PEG-J tube was placed to allow for proximal gastric decompression with the distal “jejunal” tip placed in the distal stomach to allow for nutrition optimization. After her nutrition labs improved, she was taken for a laparoscopic removal of a mesh band that was noted to be a horizontal banded gastroplasty configuration. A horizontal gastro-gastrotomy was then performed to create a wide lumen, relieving her gastric stricture. Patency of the gastro-gastrotomy was confirmed on intraoperative endoscopy, and she was discharged on post-operative day 2 tolerating a soft diet. However, she developed recurrent nausea at one month and is currently getting worked up with an upper GI study and endoscopy.