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Laprascopic Single Anastomosis Reversal of Gastric Bypass

Rajmohan Rammohan, MD, Nisha Dhanabalsamy, MD, Abhiman Cheeyandira, MD, Emanuele Lo Menzo, MD, PhD, FACS, FASMBS, Samuel Szomstein, MD, FACS, FASMBS, Raul Rosenthal, MD, FACS, FASMBS. Cleveland Clinic Florida

Introduction: Severe dumping syndrome and debilitating malabsorption syndromes are uncommon after Roux en Y gastric bypass. Laparoscopic reversal of gastric bypass is indicated to alleviate the symptoms.

Methods: We present a case of a 58 year old male with BMI 40 kg/m2, with chronic diarrhea, malnutrition, severe dumping syndrome, End Stage Renal Disease, hypoalbuminemia, copper deficiency, calciphylaxis following Laparoscopic RYGB. He was referred for Laparoscopic reversal of Gastric bypass.

Access to abdominal cavity was gained using Hassan technique. A long alimentary limb of 150 cm was found anastomosed to a micro gastric pouch at the GE junction. Due to the multiple comorbidities, standard reversal was deemed risky. Hence the single-anastomosis reversal of RYGB was performed. The alimentary limb was divided approximately 60cm distal from the gastrojejunal anastomosis and side to side gastrojejunostomy performed using a linear stapler. The remaining small bowel was resected.

Results: The patient tolerated the procedure well with minimal blood loss. Upper GI with Gastrografin demonstrated negative leak. The patient was discharged home on post-operative day 2 on regular diet. One week follow up was unremarkable.

Conclusion: Laparoscopic reversal of gastric bypass by creating alimentary limb to gastric pouch anastomosis remains a safe and acceptable revision procedure to relieve severe dumping syndrome in presence of various co morbidities


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 78886

Program Number: V091

Presentation Session: Bariatric Video Session

Presentation Type: Video

62

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