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Case Reports
. 2018 Jun 20:2018:bcr2018224759.
doi: 10.1136/bcr-2018-224759.

Laparoscopic revisional surgery for an unusual complication of Roux-en-Y gastric bypass

Micaela Raices  1 , Ignacio Fuente  1 , Fanny Rodriguez  1 , Fernando Wright  1
Affiliations
Case Reports

Laparoscopic revisional surgery for an unusual complication of Roux-en-Y gastric bypass

Micaela Raices et al. BMJ Case Rep. .

Abstract

With the worldwide epidemic of obesity, there has been an increase in the numbers of primary and revisional procedures of bariatric surgery such as the Roux-en-Y gastric bypass (RYGBP). Nevertheless, this type of surgery is not exempt from complications. An excessive length of non-functional Roux limb proximal to the jejunojejunostomy can cause abnormal upper gastrointestinal symptoms after laparoscopic RYGBP. We present the case of a female patient who presented these unspecific abdominal symptoms after laparoscopic RYGBP who underwent laparoscopic resection in order to reduce the length of the dilated blind loop responsible for the symptoms.

Keywords: gastrointestinal surgery; malabsorption.

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Conflict of interest statement

Competing interests: None delared.

Figures

Figure 1
Figure 1
Revisional surgery. (A, B, C) Arrow: jejunojejunostomy. Asterisk: dilated and devitalised afferent Roux limb at the jejunojejunostomy. (D) Arrow: triggered mechanical suture adjacent to jejunojejunostomy. Asterisk: dilated and devitalised afferent Roux limb at the jejunojejunostomy. Arrowhead: biliopancreatic limb.
Figure 2
Figure 2
Final step of laparoscopic Roux-en-Y gastric bypass. (A) Arrowhead: gastrojejunostomy. Arrow: jejunojejunostomy. Asterisk: gastric limb. (B) Mechanical suture triggered to divide the loop that connects the gastrojejunostomy with the jejunojejunostomy. Arrowhead: gastrojejunostomy. Arrow: jejunojejunostomy. Asterisk: gastric limb. (C) Arrowhead: gastrojejunostomy. Arrow: jejunojejunostomy. Asterisk: gastric limb. Square: biliopancreatic limb.
Figure 3
Figure 3
(A) Correct placement of the foot of the Roux-en-Y. (B) Long blind loop adjacent to the gastrojejunostomy (Candy Cane syndrome). (C,D) Long and dilated blind loop adjacent to the jejunojejunostomy (Inverted Candy Cane syndrome).
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