Background

The video presents a patient with history of open non divided gastric bypass. She presented with numerous complaints including episodic crampy lower abdominal pain with prior imaging showing intussusception at the jejunojejunostomy, post prandial emesis in the setting of hiatal hernia, candy cane, and stable Barrett's esophagus, as well as constipation and a component of weight recidivism. Notably she had no vitamin deficiencies. To briefly summarize the operation, we performed a hiatal hernia repair and candy cane resection to address the patient's post prandial vomiting, we resected the jejunojejunostomy to address the intermittent intussusception, and reconstructed in a way that is expected to provide additional weight loss and possibly improve the patient's constipation. Postoperatively the patient did well and at her 3 month follow up visit she was doing well and did not have any recurrence of postprandial vomiting or lower abdominal pain. She had also lost 34 lbs. Revisional surgery can be difficult both from a technical and from a conceptual standpoint. These cases often defy a 'one-size-fits-all' solution and instead require us to think 'outside the box.' When considering a patient for revisional surgery one must thoughtfully consider how a patient's symptoms correlate with their anatomy and tailor the intervention according to the patient's unique characteristics. This case demonstrates a method for reconstruction after the resection of a jejunojejunostomy that could be considered for patient's that would benefit from additional weight loss if they have not had issues with vitamin deficiencies.