Background

Although uncommon, significant weight regain after gastric bypass can occur. Options are somewhat limited to help patients achieve additional weight loss and improved techniques for revisional surgery are needed. Although limited data exists regarding distalization of the Roux limb to achieve improved malabsorption through lengthened biliopancreatic limb and increased malabsorption, we have seen good results in patients undergoing this procedure. We present a video describing our technique for increasing malabsorption after prior gastric bypass through distalization of the Roux limb to achieve improved weight loss. We highlight technical pearls to maximize effectiveness and minimize long term complications and side effects.