Lionel Rebibo1,2, Adrien Faul1, Hessa Alsuwaidan1, Simon Msika3,4. 1. Department of Digestive, Esogastric and Bariatric Surgery, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, F-75018, Paris, France. 2. Université de Paris, Inserm UMR 1149, F-75018, Paris, France. 3. Department of Digestive, Esogastric and Bariatric Surgery, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, F-75018, Paris, France. simon.msika@aphp.fr. 4. Université de Paris, Inserm UMR 1149, F-75018, Paris, France. simon.msika@aphp.fr.
Abstract
BACKGROUND: Roux-en-Y gastric bypass (RYGB) is considered the gold standard for surgical management of morbid obesity due to its good results on weight loss and correction of comorbidities related to obesity. However, RYGB could have some adverse effect in the mid and long term. Here, we describe simple technique for laparoscopic reversal of RYGB into normal anatomy. METHODS: The video shows our laparoscopic technique of the reversal of RYGB that was performed for severe protein deficiency. A 35-year-old woman with history of RYGB was referred to our center for restoration of normal digestive anatomy. RESULTS: A 35-year-old woman was managed for severe protein deficiency 3 years after RYGB. Renutrition was performed using peripherally inserted central catheter but nutritional status was dependent on PICC. No gastrostomy tube was implemented at the time where the patient was referred because the reversal of RYGB was decided. We found a modified RYGB with a common channel of 130 cm, an alimentary channel of 350 cm, and a biliopancreatic limb of 70 cm. Revision to normal digestive anatomy was performed using linear staplers, resection of 15 cm of the small bowel, and only one small bowel anastomosis. An uneventful post-operative course enabled rapid discharge (post-operative day 5). At 6-month follow-up, there was no more protein deficiency and the patient had acceptable weight regain. CONCLUSION: Reversal of RYGB is not usual and can be performed safely with few small bowel sacrifices. The optimization of pre-operative nutritional status is necessary to avoid complications.
BACKGROUND: Roux-en-Y gastric bypass (RYGB) is considered the gold standard for surgical management of morbid obesity due to its good results on weight loss and correction of comorbidities related to obesity. However, RYGB could have some adverse effect in the mid and long term. Here, we describe simple technique for laparoscopic reversal of RYGB into normal anatomy. METHODS: The video shows our laparoscopic technique of the reversal of RYGB that was performed for severe protein deficiency. A 35-year-old woman with history of RYGB was referred to our center for restoration of normal digestive anatomy. RESULTS: A 35-year-old woman was managed for severe protein deficiency 3 years after RYGB. Renutrition was performed using peripherally inserted central catheter but nutritional status was dependent on PICC. No gastrostomy tube was implemented at the time where the patient was referred because the reversal of RYGB was decided. We found a modified RYGB with a common channel of 130 cm, an alimentary channel of 350 cm, and a biliopancreatic limb of 70 cm. Revision to normal digestive anatomy was performed using linear staplers, resection of 15 cm of the small bowel, and only one small bowel anastomosis. An uneventful post-operative course enabled rapid discharge (post-operative day 5). At 6-month follow-up, there was no more protein deficiency and the patient had acceptable weight regain. CONCLUSION: Reversal of RYGB is not usual and can be performed safely with few small bowel sacrifices. The optimization of pre-operative nutritional status is necessary to avoid complications.
Entities:
Keywords:
Normal anatomy; Protein deficiency; Reversal procedure; Roux-en-Y gastric bypass