Background

48-year-old female with a past medical history of gastroesophageal reflux disease, hypertension, hyperlipidemia, obstructive sleep apnea, hiatal hernia, deep vein thromboses and pulmonary embolism on apixaban underwent an uneventful laparoscopic Roux-en-Y gastric bypass in July 2018. She had a BMI of 38 kg/m2. Her past surgical history was notable for cholecystectomy. Two weeks post-op she developed nausea, vomiting, dehydration, and dysphagia, which persisted despite consultation with a dietician, psychologist, and treatment with Pancrelipase and Metoclopramide. Ten months post-op she had lost 105 pounds and her BMI decreased to less than 20 kg/m2. She underwent esophagogastroduodenoscopy, which did not show strictures or ulcers, and CT scan, which was unrevealing. Despite close follow-up, at three years post-op her BMI had decreased to 18 kg/m2 and the patient continued to report nausea and vomiting, prompting her to request reversal of her bypass. Bypass reversal was done laparoscopically with the roux limb preserved due to the patient’s malnutrition. She recovered well post-op and was discharged to home one week later, without complications. Three months following her bypass reversal, her nausea and vomiting had resolved, and her weight had increased to 140 pounds with a BMI of 24.2 kg/m2. This case demonstrates that laparoscopic reversal of a gastric bypass is a treatment of last resort but can be done safely. Preservation of the roux limb should be considered in cases of malnutrition.