Background

Sleeve gastrectomy is the most frequently performed bariatric surgery, though up to 20% of patients require revisional surgery for complications such as weight loss failure and intractable reflux. We describe the case of patient with an ileal conduit who underwent revisional surgery for weight recidivism after primary sleeve gastrectomy.

Methods

The patient is a 57-year-old female with a history of severe obesity with comorbid insulin-dependent type 2 diabetes, hypertension, hyperlipidemia, coronary artery disease, and venous thromboembolism. Her surgical history includes cystectomy and ileal conduit for a chronic urethrovaginal fistula and a prior sleeve gastrectomy. After an initial 100 pound weight loss, she had recurrence of weight gain and multiple comorbidities. She presented with persistent severe obesity and a debilitating ventral hernia, for which she was recommended to lose weight prior to repair. She proceeded with revisional surgery following unsuccessful weight loss attempts.

Results

The planned operation was a revisional duodenal switch, though the patient ultimately underwent re-sleeve gastrectomy after extensive intra-abdominal adhesions were encountered related to the patient's complex surgical history. Post-operatively, the patient required two endoscopic dilations and short-term distal enteral feeding for PO intolerance caused by a narrowing in the distal gastric body. Within 30-days, her symptoms improved and she was tolerating adequate intake of soft foods.

Conclusions

While revision to duodenal switch has proven more efficacious than re-sleeve gastrectomy, re-sleeve gastrectomy was more feasible in our patient with an ileal conduit and intra-abdominal adhesive disease.