Newly reported complication after gastric bypass: vertical band through the gastrojejunostomy

Hossam S Alslaim, MD, Renee Hilton, MD. Augusta University

Roux-en-Y gastric bypass (RYGB) is one of the most common procedures currently performed for surgical treatment of morbid obesity in the United States. Dysphagia and chronic abdominal pain after RYGB for morbid obesity are common and often these complications have multiple etiologies. Determining the exact etiology can be challenging but necessary to provide adequate symptom relief. We present a 39-year-old female who underwent RYGB 10 years ago that was complicated by ulceration, perforation and surgical revision. She presented with progressive dysphagia and abdominal pain. Upper digestive endoscopy revealed a vertical tissue band at the gastrojejunal anastomosis. After complete work up to rule out other causes of abdominal pain and dysphagia, she underwent an interventional endoscopy with resection of the band. At follow up she has had complete symptom resolution. Post-operative GI symptoms after RYGB are common. The differential diagnosis for these presentations is broad and the symptoms alone are poor predictors of the endoscopic pathology. Along with our specific case report we discuss treating dysphagia following RYGB based on literature review. With the increasing number of patients undergoing bariatric procedures, not only bariatric surgeons, but also primary providers, general surgeons, and gastrointestinal physicians must understand the treatment of the variable complications. Endoscopy provides a minimally invasive approach to treating complications after surgery, and many times can avoid the need for additional invasive surgery.