Background

Roux-en-Y gastric bypass (RYGB) is an efficient and safe metabolic and bariatric procedure, but long term complications may include marginal ulcers at the gastrojejunostomy (GJ) and possible bile reflux if a short Roux limb is present. We introduce the case of a 57 year old female with a prior laparoscopic RYGB complicated by chronic marginal GJ ulcers and bleeding with obstruction refractory to medical and endoscopic therapies. She was consented for a robotic GJ reconstruction and Roux limb distalization to elongate the Roux limb as a result of her preoperative work up.The procedure was performed with the robotic platform without complications. The patient underwent a successful GJ anastomosis reconstruction along with transposition of the biliopancreatic (BP) limb to distalize the Roux limb and prevent further bile reflux. Postoperative hospitalization and subsequent outpatient follow up were satisfactory, with endoscopy at 3 years showing no complications and with adequate quality of life.RYGB may lead to chronic marginal ulcers that might require robotic revision with GJ reconstruction and possible Roux limb distalization to prevent further bile reflux. The use of the robotic platform offers multiple ergonomic advantages in metabolic and bariatric surgery, particularly for revisions. Good surgical judgment always takes precedence over the type of MIS approach selected.