Background

Adjustable gastric band (AGB) may lead to several long-term complications that may require conversion to Roux-en-Y gastric bypass (RYGB) as a single stage or as a 2nd stage procedure. We present the case of a 47 y/o female with BMI of 56 and a prior laparoscopic ABG that led to slippage and dysphagia requiring an open removal of the band by another surgeon. This led to an anterior abdominal wall hernia and a hiatal hernia. The patient was evaluated by a multidisciplinary panel of experts who considered her an appropriate candidate for a robotic 2nd stage RYGB.The 2nd stage RYGB was performed with the robotic platform after extensive laparoscopic adhesiolysis. The hiatal hernia repair was done primarily. However, during creation of the gastrojejunostomy (GJ) with the omega loop technique, a simple maneuver that allowed for twisting of the loop configuration represented a significant technical error that led to the complication of a Roux-en-O creation.This complication was detected intraoperatively at the time of running what was presumed to be the Roux limb after creation of the GJ anastomosis. Once it was obvious that the mislabeled Roux limb was the biliopancreatic (BP) limb in reality, and vice versa, both jejunal limbs were marked with stitches. The GJ was resected and redone after arranging the actual Roux limb and BP limb in the proper configuration without any doubt.The rest of the procedure went on without any issues, and the same was true of the postoperative course and 1-year follow up.