Background

Gastric bypass reversal is a rare revisional surgery in bariatrics. The indications are for severe symptoms or recalcitrant pathology. With gastric bypass reversal, the Roux limb may need to be preserved for intestinal length to prevent small bowel syndrome. We present a 38-year-old female patient with a previous history of a laparoscopic gastric bypass one decade ago. Her post-operative course was complicated by failure to thrive, requiring gastrostomy tube placement. She also developed small bowel intussusception requiring laparoscopic small bowel resection. The patient presented to us years later with intractable nausea and weight loss. She was total parenteral nutrition dependent with multiple PICC line complications. Pre-operative upper GI series demonstrated evidence of esophageal reflux, large gastric pouch and tortuosity of the Roux limb. We subsequently performed laparoscopic gastric bypass reversal, small bowel resection, gastric wedge resection and intraoperative endoscopy. A gastrogastrostomy was performed utilizing a linear stapler and double layer sewn closure of the common gastrotomy. The Roux limb was completely excised and removed, after measuring the remaining intestinal length to be greater than 270 cm. Postoperatively she has had resolution of her symptoms and no longer requires total parenteral nutrition. She does not exhibit symptoms of short bowel syndrome. Overall, there remains a paucity of long-term data on the incidence and outcomes of gastric bypass reversal. Published small series suggest improvement of symptoms with low complication profile.