Background

Severe malnutrition or recalcitrant marginal ulcers after Roux-en-Y gastric bypass (RYGB) are indications for surgical RYGB reversal. There are multiple surgical options for reversal procedures. We aim to present an overview multimedia video describing different available techniques for RYGB reversal.

Methods

In order to highlight the different bypass reversal techniques, we combined four different procedures done in multiple leading centers and highlighted each procedure individually. Starting with a three anastomosis RYGB reversal, we identified the gastrojejunostomy and transected the gastric pouch. Subsequently, we resected the jejunojejunostomy and re-established intestinal continuity with two bowel anastomoses: the first between the proximal roux limb (RL) and distal bilio-pancreatic (BP) limb, the second between the distal RL and the common channel (CC). For the two-anastomosis reversal, the BP limb was transected from the RL-CC complex without narrowing the bowel. In the third video, we elected to do a one-anastomosis reversal with resection of the patient’s very short RL (45 cm). Finally, the last patient suffered from severe malnutrition which led us to do a one-anastomosis reversal, preserve a short portion of his RL and place a feeding tube in the RL to maintain a source of feeding.

Results

Apart from the last patient, all reversals were indicated for recalcitrant marginal ulcers. No immediate or 30-day complications were reported. We noted a resolution of diarrhea and adequate weight gain for the patient with malnutrition.

Conclusions

Multiple feasible techniques are available for reversal of RYGB depending on the patient’s clinical status and indication for reversal.