Laparoscopic Reversion of One-Anastomosis Gastric Bypass to Normal Anatomy: Case Series and Literature Review.

BACKGROUND Revisional bariatric surgeries to other restrictive or malabsorptive procedures are considered for inadequate weight reduction, weight regains, or complications. Literature on the application of reversion of one-anastomosis gastric bypass (OAGB) to normal anatomy is limited. We aimed to report our experiences with 5 OAGB reversion surgeries to normal anatomy that were conducted for different reasons. CASE REPORT Case 1: A 40-year-old woman underwent OAGB. She had peripheral neuropathy, lower limb edema, food intolerance, and biliary reflux. For those reasons, we performed revisional surgery. Case 2: A 30-year-old woman underwent OAGB. She had tiredness, dizziness, multiple fainting, and lower limb edema. Laboratory results showed hypoglycemia, mild hypoproteinemia, and proteinuria. Dietary instructions were unsuccessful. Therefore, we performed revisional surgery. Case 3: A 40-year-old woman underwent OAGB. She had reached a body mass index (BMI) of 19, which was not appreciated by her social contacts and caused her to experience depression. After a psychiatric assessment, she insisted on revisional surgery. Case 4: A 28-year-old woman underwent OAGB. Her BMI was 18, which was not accepted by her spouse, who criticized her body image. For that, we did revisional surgery. Case 5: A 52-year-old woman with hypothyroidism underwent OAGB. She had poor compliance with dietary instructions, complicated by liver failure, which was conservatively managed. She underwent revisional surgery after optimizing her condition. She was discharged in stable condition. CONCLUSIONS A multidisciplinary team should evaluate patients, and the decision to revise should come only after the failure of all conservative management methods.

Hepaticojejunostomy for the management of sump syndrome arising from choledochoduodenostomy in a patient who underwent bariatric Roux-en-Y gastric bypass: A case report.

INTRODUCTION: Rapid weight loss following bariatric surgery is associated with high incidence of gallstones and complications that may need bilioenteric diversion. This presents a specific challenge in the management of this group of patients. CASE PRESENTATION: A 37 years old female underwent a Roux-en-Y gastric bypass (RYGB) in 2008 for morbid obesity. In 2009 she presented with obstructive jaundice and was diagnosed with choledocholithiasis successfully managed by open cholecystectomy and choledochoduodenostomy. In the following years, she developed recurrent attacks of fever, chills, jaundice, and right upper quadrant pain and her weight loss was not satisfactory. Imaging of the liver showed multiple cholangitic abscesses. Reflux at the choledochoduodenostomy site was suggestive of sump syndrome as a cause of her recurrent cholangitis and a definitive surgical treatment was indicated. Intraoperative findings confirmed sump at the choledochoduodenostomy site and also revealed the presence of a large superficial accessory duct arising from segment four of the liver with separate drainage into the duodenum distal to the choledochoduodenostomy site. A formal hepaticojejunostomy was done after ductoplasty. The Roux limb was created by transecting the jejunum 40cm distal to the foot anastomosis of the RYGB. The gastric limb was lengthened as part of this procedure which afforded the patient the additional benefit of weight loss. CONCLUSION: Choledochoduodenostomy should be avoided in patients with RYGB due to the risk of sump syndrome which requires conversion to a formal hepaticojejunostomy.