Background

This video abstract details the case of a laparoscopic limb distalization performed for weight regain after roux en y gastric bypass. The patient is a 32 year old female who underwent gastric bypass in 2010 for a pre-operative weight of 400 lbs (BMI 67). Post-operative nadir was 250 lbs (BMI 41). She presented to us in 2019 weighing 330 lbs (BMI 54) complicated by osteoarthritis of the knees. She was referred to medical weight loss specialists and was trialed on multiple medications. She underwent two endoscopic revisions but success was limited. Pre-operative work up included an UGI and EGD, and she was deemed a good surgical candidate. The video details the technique of lengthening the biliopancreatic limb in order to shorten the common channel. The patient subsequently did well and weighed 305 lbs (BMI 51) at thirty days post-operatively. Weight regain after gastric bypass is a challenging problem, and limb distalization is a viable option. Extensive patient counselling and careful patient selection is imperative in pre-operative planning. Current controversies of this technique include lengthening the roux versus the BP limb and the optimal length of the common channel.