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  • 1306
  • 2014-09-11

Successful laparoscopic reversal of Roux-en-Y gastric bypass in a patient suffering from malnutrition authored by JY Park and YJ Kim (Soonchunhyang University Seoul Hospital, Seoul, South Korea)

Epublication WebSurg.com, Sep 2014;14(09). URL:
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The video entitled "Successful laparoscopic reversal of Roux-en-Y gastric bypass in a patient suffering from malnutrition", authored by JY Park and YJ Kim (Soonchunhyang University Seoul Hospital, Seoul, South Korea) is analyzed by Dr. Michel Vix, MD (Nouvel Hôpital Civil, Strasbourg, France), sharing in this way his own personal experience and highlighting the different surgical approaches available with tips and tricks.
Reply from Dr. Ji Yeon Park to the reviewer: The South Korean surgeon in the current case, who originally was a gastric cancer surgeon, was extremely inexperienced in bariatric surgery at the time of the primary surgery in this patient. He applied “uncut” Roux-en-Y reconstruction for gastric cancer surgery to RYGB in this patient; it is a simple modification of Billroth II with Braun anastomosis with additional occlusion of the jejunogastric pathway with a non-bladed linear stapler. Consequently, sufficient distance between the gastrojejunostomy and the jejunojejunostomy was preserved in order to prevent bile reflux into the remnant stomach when staple-line recanalization occurs. However, intraoperative findings at reversal showed that the previously uncut staple line was found split apart, far from being recanalized. This consequently resulted in a long “true” blind loop at the distal end of the biliopancreatic limb. At reversal, we established a new jejunojejunal anastomosis between the distal end of the blind loop and the cut end of the proximal alimentary limb, and left the old jejunojejunostomy in situ. The operative procedure per se became much simpler by not dismantling the old jejunojejunostomy; as a result, the number of new anastomoses and the operating time could be reduced.