Background

We describe the case of a 39-year-old female patient with a history of biliopancreatic diversion with duodenal switch performed in 2021. The patient presented with significant signs of malnutrition and a weight of 132 lbs. She was placed on TPN and optimized prior to proceeding with revisional surgery to manage the malnutrition. We started the procedure by accurately measuring the bowel lengths. We identified a common channel (CC) of 260 cm, a very short roux limb (RL) of 35 cm, and a biliopancreatic limb (BP) of 265 cm. We transected the RL from the ileo-ileostomy and reanastomosed the RL proximally on the BP limb, thus adding an additional 130 cm to the CC and elongating the total alimentary limb length. This was a linear stapled side-to-side anastomosis with staple closure of the common enterotomy. The patient did really well after the surgery. She was discharged on postoperative day 1. At her 4 weeks follow-up, she already started regaining weight and her number of bowel movements per day decreased significantly.