Background

Revisional surgery after prior gastric surgery can often be complex requiring careful planning. Although revisional bariatric surgery is becoming more commonplace, at times bariatric surgeons may be asked to help manage a patient with complications after other gastric operations. Careful operative planning is imperative to ensure a successful outcome. We present our management of a patient with prior choledochojejunostomy and partial gastrectomy with Roux-en-Y reconstruction with gastric outflow obstruction who underwent conversion to partial gastrectomy with Roux-en-Y reconstruction incorporating choledochojejunostomy as part of biliopancreatic limb.

Methods

An 80-year-old male presented with epigastric pain and emesis after gastrojejunostomy and choledochojejunostomy reconstruction for a gastroduodenal resection due to B-cell lymphoma. Esophagogastroduodenoscopy (EGD) demonstrated an ulcerative stricture with benign pathology. The patient underwent laparoscopic conversion to more standard gastric bypass through partial gastric resection with creation of a new roux limb and a biliopancreatic limb that utilized the prior choledochojejunostomy as a portion of the biliopancreatic limb. He had complete resolution of symptoms with improved dietary tolerance and weight gain. He did have a remote upper endoscopy with dilation for gastrojejunostomy stricture with resolution of symptoms. At one year follow up, the patient was well, without issues, gaining weight appropriately and with an incred quality of life.

Conclusions

We demonstrate conversion of a gastrojejunostomy with choledochojejunostomy to a small gastric pouch with Roux-en-Y reconstruction using previously created choledochojejunostomy as part of the biliopancreatic limb. Careful intraoperative evaluation of prior operative anatomy is imperative to avoid intraoperative confusion and complications.