Surgical Management of Failed Roux-en-Y Gastric Bypass (RYGB) Reversal: A Case Study

Cureus · 4 authors, 3 centres

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TL;DR

This case report describes a single patient with recurrent anastomotic ulceration after Roux-en-Y gastric bypass who underwent RYGB reversal to restore normal anatomy.

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This case report describes a single patient with recurrent anastomotic ulceration after Roux-en-Y gastric bypass who underwent RYGB reversal to restore normal anatomy. Post-reversal, the patient did not improve and developed a stenosed gastrogastric anastomosis along with malnutrition secondary to intractable nausea and vomiting requiring total parenteral nutrition. The authors attribute the gastroesophageal reflux and marginal ulcer formation to impaired drainage from the stenotic anastomosis. The patient presented approximately two and a half years after reversal, providing a longer-than-usual follow-up perspective given that most published studies report limited follow-up. The authors note a paucity of data on late post-RYGB reversal complications and call for longer follow-up studies with higher levels of evidence.

STUDY TYPE

case_report

SPECIALTY

surgery

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ORIGINAL PAPER

PMC10117986

Surgical Management of Failed Roux-en-Y Gastric Bypass (RYGB) Reversal: A Case Study

Cureus

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ABSTRACT

Abstract With the growing obesity epidemic, surgeons are performing more bariatric surgeries, including Roux-en-Y gastric bypass (RYGB) reversals. Although studies have identified indications for RYGB reversals, little information is available about the long-term effects of the procedure. We wish to highlight a case with long-term complications of RYGB reversal and subsequent management. We present a patient with multiple abdominal surgeries including an RYGB reversal that was complicated by a stenosed gastrogastric anastomosis that caused several gastrojejunostomy ulcerations and malnutrition secondary to intractable nausea and vomiting. A 51-year-old female with a complex surgical history including a simple RYGB reversal in 2019 presented to the ER with complaints of abdominal pain, uncontrolled diarrhea, and an inability to tolerate food for six months. Workup revealed multiple marginal ulcers at the remnant jejunum attached to the gastric pouch, and a stenosed gastrogastrostomy placed high along the cardia of the remnant stomach and pouch. This stenosis resulted in a nonfunctional, nondependent reversal that only drained when filled. Ultimately, a large gastrotomy was performed, and an endoscope was utilized to identify a small pinhole connection between the patient’s pouch and the remnant stomach along the superomedial portion of the remnant stomach’s fundus. The anvil of a 60 mm GIA black load stapler was guided through and fired twice to come across the stricture. After the stricture was completely crossed, the endoscope was passed through, confirming that it was widely patent. The postoperative course was uneventful, and the patient was discharged with total parenteral nutrition (TPN) on postoperative day 15 before being discontinued at her follow-up visit. She reported that she had been gaining weight and eating well. Long-term complications following RYGB reversal are not well-discussed in the literature. This case offers insight into such complications, discusses the surgical technique utilized to fix them, and calls for further research on the topic to better inform surgeons and patients alike. Keywords: gastrogastric stenosis, chronic marginal ulcers, complication, bypass reversal, bariatric surgery, obesity

CITATION EXPORT

Angie S Kim, Matthew Nester, Kristina T Gemayel et al.. Surgical Management of Failed Roux-en-Y Gastric Bypass (RYGB) Reversal: A Case Study. Cureus. (2023). https://doi.org/10.7759/cureus.36477

AUTHORS

4 · 3 CENTRES

Angie S Kim, Matthew Nester, Kristina T Gemayel, Joseph A Sujka

1 Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
2 Plastic Surgery, University of South Florida/Tampa General Hospital, Tampa, USA
3 General, Bariatric, Foregut, Hernia, University of South Florida/Tampa General Hospital, Tampa, USA