Purpose:
Single loop gastric bypass (SLGB) is an alternative procedure to the Roux-en-y gastric bypass (RYGB); the latter being the gold standard approach for surgical management of morbid obesity in Australia. Concerns exist regarding possible long-term complications from SLGB specifically related to bile acid reflux and associated oesophagitis and marginal ulcer formation.(1-5) Our group has now performed SLGB as both a primary procedure and as a revisional procedure for gastric banding for three years. A number of these have had to be converted to a roux loop. We would like to present the outcomes of twelve cases explaining the indication for conversion to Roux and in some cases refashioning of the gastrojejunostomy; providing an intraoperative video example of this.
Methods:
From September 2015 to April 2017, twelve patients underwent laparoscopic revision of their SLGB to a roux limb performed via a 5-port technique. Three of the cases required resection and then refashioning of the gastro-jejunostomy along with formation of a new jejuno-jejunostomy. In the remaining nine, the biliary limb was detached from the gastro-jejunostomy and re-inserted as a new roux limb 50cm distally.
Results:
Indication for roux-limb was bile-reflux in 58% of the cases. Median time from SLGB to revisional RYGB was 6.5 months. All patients recovered well with good resolution of their prior symptoms. One case had a complication from surgery necessitating re-operation for reduction of internal hernia. Two others required subsequent laparoscopic division of adhesions for pain.
Conclusion:
It is imperative that with the growing popularity of the SLGB procedure, bariatric surgeons can successfully perform revisonal roux-loop surgery if complications arise. We present 12 cases with good results of symptom resolution and a video outlining one successful case that required refashioning of the gastro-jejunostomy. We will discuss the evolution of this technique and limitations of this emerging issue.