IBC Oxford University Poster Abstract 4 - Cicatrized ulcer at the gastro-jejunostomy in OAGB case managed by conversion to RYGB

Abstract Background One Anastomosis Gastric Bypass (OAGB) has gained popularity over the years since introduced by Rutledge in 1997. It has been proposed as a simpler and efficient weight-reducing surgery. It offers improvement/cure for many parts of metabolic syndrome, especially diabetes and hypertension. Needless to mention its effects on sleep apnoea syndrome, osteoarthritis, and many other diseases related to obesity. However, it comes with many risks as well, starting from leakage and bleeding to long-term nutritional deficiencies. Biliary reflux is a fearful complication whose incidence is not accurately reported. There are few papers in the literature talking about stomal ulcers after OAGB, with some of them talking about perforated ulcers. Case Presentation We present here a case with the history of OAGB that was done two years before presentation with a weight of 117 kg and a height of 175 cm (BMI = 38.2 kg/m2). He came with a complicated stomal ulcer ending in fibrosis as diagnosed with upper endoscopy and 3D CT volumetry. This led to obstruction of the gastro-jejunostomy with severe vomiting and malnutrition. His BMI at presentation was 17 kg/m2. The patient tried medical treatment, but it failed because of the fibrosis at the level of GJ anastomosis. We went for exploratory laparoscopy aiming at resection of the fibrotic part and going for RYGB. The GJ was adherent to the stomach anteriorly and the remnant stomach posteriorly, so we had to do some sort of partial gastrectomy to be able to resect the fibrotic area and be able to create a pouch for RYGB. We did RYGB with 50 cm BP limb length and 50 cm for the alimentary limb aiming at relieving obstruction not for weight loss. Results The patient was admitted to the hospital for 5 days to monitor his vitals as well as his tolerance to fluids. He was discharged then and follow-ups after two weeks, 6 weeks then two months were unremarkable. Conclusion There are few papers about stomal ulcers after OAGB, and perforating cicatrized ulcers might not be mentioned in the literature to our knowledge.