Maria C Fonseca, MD, Coney Bae, MD, Camila Ortiz-Gomez, MD, Joel S Frieder, MD, Emanuele Lo Menzo, MD, PhD, FACS, FASMBS, Samuel Szomstein, MD, FACS, FASMBS, Raul J Rosenthal, MD, FACS, FASMBS. Cleveland Clinic Florida
A 52-year-old active smoker with a history of Roux-en-Y gastric bypass (RYGB) 15 years prior presents with recalcitrant diarrhea, weight loss and malnutrition. To ameliorate his dumping syndrome, we performed a laparoscopic reversal of RYGB. After careful lysis of adhesion, a retrocolic, retrogastric RYGB anatomy with 250cm biliopancreatic and 75cm roux limb was found. The distal end of the Roux limb was divided and brought to the remnant stomach to create a side-to-side neo-gastrojejunostomy in an antecolic fashion. Post-operatively he had an episode of melena but remained hemodynamically stable with normal hemoglobin. Upper GI on post-operative day (POD) one demonstrated no evidence of leak. The patient tolerated clears and was discharged home. On POD 7, he presented to the emergency room with pneumoperitoneum. He was emergently taken to the operating room for an exploratory laparotomy where an intact anastomosis and a distant perforation in the alimentary limb were found. The abdomen was washed out, and the perforation was repaired primarily. A subsequent upper GI revealed the intact repair, and the patient was eventually discharged with resolution of diarrhea. Intractable dumping syndrome can be ameliorated by reversal of RYGB via neo-gastrojejunostomy. In re-operative patients with altered anatomy and smoking history, smoking cessation, nutritional optimization and careful surgical conduct can help reduce post-operative complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95372
Program Number: V232
Presentation Session: Video Loop Day 2
Presentation Type: VideoLoop
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