Background

A 58-year-old female presented to the clinic with severe reflux symptoms and food regurgitation that developed one year back. The patient reported underwent one anastomosis gastric bypass in 2019 which was reversed 6 months later upon patient's request. Upper endoscopy showed twisting in the mid of the stomach causing narrowing.Upper gastrointestinal series showed focal gastric antrum luminal narrowing at the site of the gastrogastric anastomosis with partial obstruction. The patient was taken for diagnostic laparoscopy, revision of gastric anastomosis and possible Roux en Y gastric bypass. We started taking down the adhesions between the stomach and the liver. The greater omentum was covering the gastrogastric anastomosis and adhering to the liver and causing twisting of the stomach along its vertical axis. A sharp angle was noted in the mid stomach due to an adhesive band, that was released. An upper endoscopy was done intra operatively showing patent gastrogastric anastomosis with food particles beyond the anastomosis part indicating that the area of obstruction is distal to it. At the point of angulation, the scope was passed with difficulty and the twist was seen clearly intra luminally. Decision was made to revise the sharp angulation point by taking a stitch at the anterior wall of the stomach to untwist it. Gastrotomy was made and stapler was introduced proximal and distal to the angle. Patient did well and had a smooth post operative course.