Background

The Mini-Gastric Bypass (MGB) is an effective procedure for obesity and its metabolic derangements, but can lead to bile reflux, hindering patient quality of life and increasing the risk of esophageal adenocarcinoma. Conversion of the former into the Roux-en-Y Gastric Bypass (RYGBP) to treat this post-operative complication is demonstrated in this video case report.

Methods

45-year-old Female presents to the University of Missouri Bariatric Clinic 10 years after a MGB. The patient had lost 93% of her excess BMI (from 39.5 to 26) but developed biliary reflux and weight regain to a BMI of 35. She had undergone a Braun entero-enterostomy without resolution of bile reflux symptoms. Upper Endoscopy confirmed the presence of bile in her stomach without Barrett's esophagus. The patient was consented for laparoscopic conversion of Loop to RYGBP. Operative time was 134 minutes. Her Roux limb was 150cm, biliopancreatic limb 50cm. Her pouch from her prior MGB was adequate and measured 5cm in length. She had symptom resolution, tolerance of diet and discharge to home on post-operative day 1. Six months of follow up identified no complications, but her BMI rose to 36.9

Conclusions

Revisional surgery of Loop to RYGBP is effective in treating bile reflux. Takedown of the anastomosing jejunum between afferent and efferent portions of the braun enterostomy restores intestinal continuity from pylorus to ileocecal valve. This can then be manipulated to generate roux and BP limbs. As the amount of intestine bypassed can change, weight fluctuations can occur after this revision.