Abstract
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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References
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Carbajo MA, Luque-de-León E, Jiménez JM, et al. Laparoscopic one-anastomosis gastric bypass: technique, results, and long-term follow-up in 1200 patients. Obes Surg. 2016.
Bruzzi M, Chevallier JM, Czernichow S. One-anastomosis gastric bypass: why biliary reflux remains controversial? Obes Surg. 2017;27:545–7.
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Amor, I.B., Petrucciani, N., Kassir, R. et al. Laparoscopic Conversion of One Anastomosis Gastric Bypass to a Standard Roux-en-Y Gastric Bypass. OBES SURG 27, 1398 (2017). https://doi.org/10.1007/s11695-017-2646-1
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DOI: https://doi.org/10.1007/s11695-017-2646-1