Background

The patient is a 57-year-old woman with long-standing diabetes and chronic narcotic use who had undergone an open Roux-en-Y gastric bypass (RYGB) reversal for an enlarging marginal ulcer, and presented 11 years later with symptoms of severe bile reflux and regurgitation related to ongoing gastroparesis evident on preoperative esophagogastroduodenoscopy (showing copious food debris proximal to the gastrogastrostomy) and gastric emptying study (with gastric retention of 72% at 4 hours). Since she was experiencing bile reflux with pooling of contents proximal to her gastrogastrostomy, we proceeded with a laparoscopic redo RYGB with a near esophagojejunostomy. The patient’s reversal had included retention of the Roux limb with anastomosis to the biliopancreatic limb. Staple loads were used to divide this anastomosis and the stomach distal to the gastrogastrostomy. The Roux limb was then brought up in a retrocolic, retrogastric fashion with completion of a handsewn, end-to-end anastomosis, leaving a small cuff of stomach beyond the z-line. A paraesophageal hernia was repaired, internal hernia spaces were closed, and drains were placed for early detection of a leak. Her hospital course was complicated by a small bowel obstruction related to adhesions from a surgical drain. A gastric remnant drain was placed on postoperative day 3 for decompression, and the patient returned to the operating room on postoperative day 7 for laparoscopic lysis of adhesions and g-tube formalization. Following this, her symptoms of bile reflux and regurgitation resolved. She tolerated g-tube clamping, was advanced to a bariatric soft diet, and was discharged on postoperative day 16.