Revisional bariatric surgery presents a unique set of challenges, particularly in the setting of a prior open index procedure. We present a video case report of successful revision of a patient with a previous open, retro-colic, non-divided gastric bypass that developed stenosis of the gastrojejunostomy and a gastro-gastric fistula, demonstrating our technique and management of the Roux limb.


52-year-old female with prior non-divided gastric bypass underwent planned laparoscopic conversion to divided Roux-en-Y gastric bypass. The patient suffered from obesity with a BMI of 57.1 kg/m^2, and lack of weight loss success, likely in part due to a fistulous connection to remnant stomach. After adequate bowel length was confirmed, the Roux limb was resected during small bowel reconstruction. The patient overall did well postoperatively and was discharged after 4 days.


Revisional surgery can be challenging but often offers patients positive outcomes when experiencing complications or weight regain after prior weight loss surgery. When converting a non-divided gastric bypass to divided gastric bypass, we recommend resection of gastrojejunostomy with reconstruction of appropriate sized pouch if enlarged, and in this case, removal of the fistula and connected remnant stomach. Furthermore, we recommend removing the Roux limb to avoid leaving a blind segment of intestine in the abdomen. This difficult procedure can be performed safely but requires experienced hands due to the often-unpredictable intra-operative findings and concomitant need for unplanned procedural modifications.