Laparoscopic Conversion of One Anastomosis Gastric Bypass to a Standard Roux-en-Y Gastric Bypass

Mar 18, 2017Obesity surgery

Switching from One-Anastomosis to Standard Roux-en-Y Gastric Bypass Surgery Using Laparoscopy

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Abstract

A 51-year-old woman with a BMI of 41 kg/m2 underwent conversion from an anastomosis gastric bypass (OAGB) to a Roux-en-Y gastric bypass (RYGB) to address chronic bile reflux.

The patient experienced recurrent heartburns one year after the OAGB procedure.
Upper GI endoscopy revealed pouchitis and bile reflux in the esophagus.
Medical treatment for gastroesophageal reflux disease was ineffective.
The conversion involved resecting the gastrojejunal anastomosis and creating a new gastric pouch.
This technique effectively addressed the biliary reflux by restoring normal anatomy.

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INTRODUCTION: One anastomosis gastric bypass (OAGB) demonstrated results similar to traditional Roux-en-Y procedures [1-3], in terms of weight loss and resolution of obesity-related comorbidities. The main controversy regarding OAGB is the concern for an association between biliary alkaline gastritis and esophageal or gastric cancer raised by some studies [4].

METHODS: We present the case of a 51-year-old woman with a BMI of 41 kg/m2 who underwent a laparoscopic OAGB in 2014. One year later, she consulted for recurrent heartburns. An upper GI endoscopy showed pouchitis and bile reflux in the esophagus. Medical treatment of gastroesophageal reflux disease was ineffective. We decided to convert the OAGB to a Roux-en-Y gastric bypass (RYGB).

RESULTS: In this video, we show how to revise an OAGB to treat chronic bile reflux, by converting the procedure to a standard RYGB. The intervention starts by restoring the normal anatomy of the small bowel, with the resection of the gastrojejunal anastomosis, which was located at 250-cm du Treitz's ligament. Then, the gastric pouch is created. A standard Roux-en-Y gastric bypass is performed.

CONCLUSIONS: The resection of the gastrojejunal anastomosis allows fashioning the Roux-en-Y limb with the classical measures. This technique allows a conversion to a standard RYGB and is effective in treating the biliary reflux.

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Laparoscopic Conversion of One Anastomosis Gastric Bypass to a Standard Roux-en-Y Gastric Bypass

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