Florent Alcaraz1,2, Sebastien Frey1,2, Antonio Iannelli3,4,5,6. 1. Université Côte d'Azur, Nice, France. 2. Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet 2, Centre Hospitalier Universitaire de Nice, Nice, France. 3. Université Côte d'Azur, Nice, France. iannelli.a@chu-nice.fr. 4. Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet 2, Centre Hospitalier Universitaire de Nice, Nice, France. iannelli.a@chu-nice.fr. 5. Inserm, U1065, Team 8 "Hepatic complications of obesity and alcohol", Nice, France. iannelli.a@chu-nice.fr. 6. Department of Digestive Surgery, Archet 2 Hospital, University of Nice-Côte d'Azur, 151 Route de Saint-Antoine, 06200, Nice, France. iannelli.a@chu-nice.fr.
Abstract
INTRODUCTION: Small intestinal bacterial overgrowth (SIBO) is a common adverse effect after laparoscopic Roux-en-Y gastric bypass (LRYGB) and may be responsible for chronic diarrhea, abdominal pain, and discomfort. Although its pathophysiology is still unclear, surgical management may be appropriate in selected cases. METHODS: In this video, we present a surgical revision of LRYGB, 12 years after the initial surgery, for late postoperative chronic diarrhea. The diagnosis of SIBO was finally established and associated with a dilated jejuno-jejunostomy diagnosed through a small bowel follow-through. RESULTS: Revision of the RYGB was performed by resecting the dilated jejunostomy and fashioning a new one with a shorter Roux-en-Y limb. During follow-up, the patient showed fast improvement and complete resolution of symptoms was obtained at 12 months. CONCLUSION: SIBO may be responsible for postoperative chronic diarrhea in RYGB patients, possibly in the long term, and it is often misdiagnosed. Primary treatment is conservative with appropriate dietary measures, antibiotics, and probiotics but surgical management can be very effective in selected patients presenting with failure of prolonged medical treatment and an anatomic abnormality.
INTRODUCTION: Small intestinal bacterial overgrowth (SIBO) is a common adverse effect after laparoscopic Roux-en-Y gastric bypass (LRYGB) and may be responsible for chronic diarrhea, abdominal pain, and discomfort. Although its pathophysiology is still unclear, surgical management may be appropriate in selected cases. METHODS: In this video, we present a surgical revision of LRYGB, 12 years after the initial surgery, for late postoperative chronic diarrhea. The diagnosis of SIBO was finally established and associated with a dilated jejuno-jejunostomy diagnosed through a small bowel follow-through. RESULTS: Revision of the RYGB was performed by resecting the dilated jejunostomy and fashioning a new one with a shorter Roux-en-Y limb. During follow-up, the patient showed fast improvement and complete resolution of symptoms was obtained at 12 months. CONCLUSION: SIBO may be responsible for postoperative chronic diarrhea in RYGB patients, possibly in the long term, and it is often misdiagnosed. Primary treatment is conservative with appropriate dietary measures, antibiotics, and probiotics but surgical management can be very effective in selected patients presenting with failure of prolonged medical treatment and an anatomic abnormality.
Authors: Rowan F van Golen; Nadine E de Waard; Laura R Moolenaar; Akin Inderson; Stijn Crobach; Alexandra M J Langers; Bart van Hoek; Maarten E Tushuizen Journal: Case Rep Gastroenterol Date: 2022-04-04