Obesity Surgery · 4 authors, 3 centres
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This case report describes the successful conversion of a rare, unclassical open bariatric procedure into a laparoscopic Roux-en-Y gastric bypass with distalization for a 38-year-old female with weight regain. The patient achieved a significant weight loss of 57 kg in the first year after the revision surgery.
This is a case report of a 38-year-old woman who presented with weight regain and insufficient weight loss after a prior open bariatric surgery performed in 2010. Preoperative workup, including imaging and endoscopy, revealed an unclassical procedure with a preserved stomach, a gastrojejunostomy, and an enteroenteric anastomosis. A multidisciplinary team performed a laparoscopic revision, converting the procedure to a Roux-en-Y gastric bypass (RYGB) with distalization. This involved reducing the gastric pouch and adjusting bowel lengths to achieve a total alimentary limb length (TALL) of 405 cm, a common channel (CC) of 300 cm, and a biliary limb (BL) of 250 cm. The patient was discharged on postoperative day two and lost 57 kg in the first year, with her BMI decreasing from 54.4 to 33.8 kg/m². She experienced frequent dumping episodes without discomfort but had normal laboratory values and required nutritional supplements. The case highlights the utility of a multidisciplinary approach and diagnostic workup for complex revisional surgery, and it emphasizes the importance of adhering to established principles of limb length in distalization to avoid severe nutritional deficiencies.
