Reversal of Roux-en-Y Gastric Bypass to Normal Anatomy in a Severely Malnourished Patient After Metabolic Bariatric Surgery

Obesity stands as a prominent health challenge in our society, with metabolic bariatric surgery (MBS) emerging as a solution due to its efficacy in addressing obesity-related type 2 diabetes mellitus (T2DM). Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB) remain the most common MBS after sleeve gastrectomy. Complications from RYGB are uncommon but include anastomotic stricture, marginal ulcers, small bowel obstruction, and nutritional complications. We present a 52-year-old lady with an initial body mass index (BMI) of 27.6 kg/m² and poorly controlled T2DM who presented with generalized body weakness and uncontrolled weight loss after an RYGB performed four months earlier. She was cachexic with a BMI of 17 kg/m²,with generalized anasarca with a multitude of electrolyte disturbances. After nutritional optimization, she underwent a reversal surgery back to normal anatomy. Reversal of RYGB to normal anatomy is a complex surgical procedure and is often the last resort undertaken in patients experiencing severe complications from the initial surgery. Indications include malnutrition, severe dumping syndrome, excessive weight loss, and recalcitrant marginal ulcers. Our case outlines the importance of proper patient selection for MBS and highlights the preoperative management of RYGB reversal to normal anatomy. We also describe the surgical procedure using a stepwise approach. In conclusion, the reversal of RYGB to normal anatomy should only be undertaken after a careful period of prehabilitation to reduce perioperative complications. The inclusion of dietitians, endocrinologists, and physiotherapists is crucial to ensure the best possible outcome.