Background

We present a case of a 59-year-old woman presenting with severe nutritional and vitamin deficiencies,chronic malabsorptive diarrhea refractory to medical therapy, and a symptomatic umbilical hernia inneed of surgical intervention after a prior sleeve gastrectomy (DS) performed in 2014 and a subsequentconversion to BPD-DS in 2016. The patient underwent meticulous multidisciplinary management withmedical interventions until she was not able to sustain her nutrition and a robotic revision was offeredto address her primary problem. She underwent general anesthesia for a robotic re-sleeve as a result ofGERD exacerbated by a chronically dilated and abnormally shapedgastric sleeve, along with division of the biliopancreatic limb of the ileoileostomy anastomosiscorresponding to her BPD-DS anatomy to transpose it proximally and create a longer common channelwhile promoting greater absorptive capacity. In addition, she underwent resection of a redundant endof the alimentary limb at the duodenoileostomy to prevent blind loop syndrome and bacterialovergrowth. Finally, an umbilical hernia primary repair (no mesh) was performed due to a symptomatic2-cm umbilical hernia at the same time. The patient had a satisfactory hospital course and wasdischarged from the hospital a few days later, with close follow-up in clinic at 3-month intervals toensure monitoring and correction of nutritional and vitamin deficiencies in the post-operative period.Her laboratory studies demonstrated improvement and eventually correction of her deficiencies, andher GERD symptoms improved significantly due to the re-sleeve procedure.