Laparoscopic Reversal of One-Anastomosis Gastric Bypass After Sleeve Gastrectomy: A Case Report.
Source: PubMed, NCBI / U.S. National Library of Medicine
BACKGROUND One-anastomosis gastric bypass (OAGB) is an effective bariatric surgery; however, there may be serious instances of metabolic and nutritional complications that may require complete reversal. Reversal of complete OAGB to near-normal physiology, especially with a background of sleeve gastrectomy, is extremely rare. This case report discusses the complications associated with reversal of OAGB. CASE REPORT Our patient was a 28-year-old woman who had a history of a sleeve gastrectomy procedure and later underwent a revisional OAGB procedure for poor weight loss/weight regain. She later developed weakness, chronic diarrhea, vomiting, severe protein-calorie malnutrition, refractory micronutrient deficiencies, and severe liver dysfunction with significant hepatocellular damage. She was admitted in unstable medical condition. After multidisciplinary evaluation, the patient underwent a laparoscopic reversal of OAGB to near-normal anatomy. The postoperative course was complicated by septic shock and multi-organ dysfunction requiring critical care interventions. With comprehensive multidisciplinary management, the patient gradually improved. After more than 8 months of follow-up, she demonstrated recovery in nutritional status, liver function, and functional capacity, despite the presence of a reduced gastric reservoir due to prior sleeve gastrectomy. CONCLUSIONS This case confirms that complete reversal of OAGB can be life-saving in selected patients with severe malnutrition
Abstract
BACKGROUND One-anastomosis gastric bypass (OAGB) is an effective bariatric surgery; however, there may be serious instances of metabolic and nutritional complications that may require complete reversal. Reversal of complete OAGB to near-normal physiology, especially with a background of sleeve gastrectomy, is extremely rare. This case report discusses the complications associated with reversal of OAGB. CASE REPORT Our patient was a 28-year-old woman who had a history of a sleeve gastrectomy procedure and later underwent a revisional OAGB procedure for poor weight loss/weight regain. She later developed weakness, chronic diarrhea, vomiting, severe protein-calorie malnutrition, refractory micronutrient deficiencies, and severe liver dysfunction with significant hepatocellular damage. She was admitted in unstable medical condition. After multidisciplinary evaluation, the patient underwent a laparoscopic reversal of OAGB to near-normal anatomy. The postoperative course was complicated by septic shock and multi-organ dysfunction requiring critical care interventions. With comprehensive multidisciplinary management, the patient gradually improved. After more than 8 months of follow-up, she demonstrated recovery in nutritional status, liver function, and functional capacity, despite the presence of a reduced gastric reservoir due to prior sleeve gastrectomy. CONCLUSIONS This case confirms that complete reversal of OAGB can be life-saving in selected patients with severe malnutrition and metabolic issues. Early identification of nutritional deficiencies and multidisciplinary care are critical to optimize outcomes in high-risk patients following bariatric surgery.