Video case reportConversion of one anastomosis gastric bypass/mini gastric bypass to Roux-en-Y gastric bypass for bile reflux gastritis after failed Braun jejunojejunostomy
Section snippets
Case history and technique
Our patient is a 34-year-old female patient who underwent LAGB in 2006 at a private hospital for body mass index (BMI) of 51.5 kg/m2 and a weight of 120 kg. Her nadir weight was 58 kg and she underwent an abdominoplasty and multiple plastic surgery operations. She presented to a second surgeon in 2013 with a BMI of 27 kg/m2 and weight of 63.5 kg, and she underwent laparoscopic removal of LAGB for LAGB prolapse and conversion to OAGB/MGB in a single stage in 2013. Postoperatively, she developed
Methods
Patients presenting with bile reflux gastritis/esophagitis after OAGB/MGB are evaluated with upper endoscopy and radiographic barium upper gastrointestinal (UGI) studies. In addition, patients presenting with bile reflux gastritis/esophagitis initially are managed conservatively with proton pump inhibitors and sucralfate. If the patient is malnourished, they are treated with enteral nutrition through a nasojejunal tube or total parenteral nutrition (TPN) if enteral feeding is not possible. We
Results
When the patient arrived to our institution, she was malnourished, had severe bile reflux gastritis/esophagitis and failure to thrive, and was not able to tolerate oral feeding. UGI series found that she had esophageal dilation, short pouch, and passage of contrast in both limbs of the OAGB/MGB without evidence of stenosis. Upper endoscopy found that she had severe bile reflux gastritis/esophagitis and marginal ulceration. No biopsies were taken, and pathologic reflux was confirmed by the
Discussion
Our patient underwent conversion of LAGB to OAGB/MGB for LAGB prolapse when her BMI was 27 kg/m2 (weight: 63.5 kg), and she developed bile reflux gastritis. Our approach for a patient with LAGB prolapse at this weight and BMI would be to remove the LAGB only. The surgical approach chosen when she had bile reflux gastritis was Braun jejunojejunostomy, hiatal hernia repair, and Nissen/Toupet fundoplication utilizing the gastric remnant.
Surgical management of bile reflux gastritis/esophagitis
Conclusion
Conversion of OAGB/MGB to Roux-en-Y gastric bypass for bile reflux gastritis is effective when Braun jejunojejunostomy anastomosis fails.
Disclosures
The authors have no commercial associations that might be a conflict of interest in relation to this article.
Acknowledgments
For this type of study, formal consent regarding compliance with ethical standards is not required.
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