Background

Revisional bariatric surgery is complex and is performed at a much lower rate than primary bariatric surgery. Indications for revisional surgery include failure in weight reduction/weight regain, marginal ulcer, stricture, and reflux. Preoperative workup should include review of prior operative reports, upper endoscopy, and an upper GI series. This workup is more in-depth than what may needed for primary bariatric surgery. Roux-en-Y gastric Bypass (RYGB) revision techniques include puch revision, Type I: distalization of the roux limb1, and Type II: distalization of the biliopancreatic limb2. The curve of weight loss is steeper with a Type I revision2. In either case, patients must be monitored postoperative for nutritional deficiencies. We present the case of a 54-year-old female who presented to our clinic for evaluation for revisional bariatric/metabolic surgery. She had a surgical history of open RYGB (2002), laparoscopic adjustable band (2007), and exploratory laparotomy for trauma following a motor vehicle collision, during which her gastric band was removed (2017). She had experienced weight regain and reflux. A robotic assisted lysis of adhesions, gastric pouch trimming and revision of gastrojejunostomy, conversion from retro-colic retro-gastric bypass to ante-colic ante-gastric gastric bypass, distalization of bypass, hiatal hernia repair and upper endoscopy were successfully completed.