Background

This is a case of a 66 year old female with past medical history significant for morbid obesity, loop recorder placement for paroxysmal atrial fibrillation, anemia, hypertension, Roux-en-Y gastric bypass in 2007 who presented to the clinic with difficulty losing weight. Patient reported refractory weight gain despite appropriate lifestyle modifications several years postoperatively after previously having successful weight loss. She subsequently underwent gastric band placement in 2014 for weight gain which was later removed for difficulty tolerating food. She presented to the clinic to discuss surgical weight loss options, preoperative BMI at that time was 57.42 kg/m2. She underwent preoperative esophagogastroduodenoscopy which was notable for <1 cm gastric pouch and widely patent gastrojejunostomy. She also underwent mesenteric angiogram which demonstrated adequate blood flow to her stomach, and she was cleared by cardiology for surgery given her history of paroxysmal atrial fibrillation and loop recorder placement. She underwent robotic assisted gastric bypass conversion to single anastomosis duodenal switch with jejunal interposition and subtotal gastrectomy, she tolerated procedure well without immediate complications. She was discharged home on postoperative day three. She progressed well postoperatively. One year after her gastric bypass conversion, most recent BMI was 41.7 kg/m2 and she recently underwent panniculectomy for symptomatic pannus.