IBC Oxford University Oral Abstract 18 - Video abstract: LAGB to RYGB to open proximalisation to LSG to manage severe dumping syndrome

Abstract Introduction Revisional bariatric surgery is performed to repair a previous weight-loss surgery. It might be appropriate if there is less-than-optimal weight loss, weight gain, or both. There are complications from the original procedure. Complications include ulcers, pouch enlargement, reflux, or an unsatisfactory lifestyle. Revisional surgeries are often more complex than initial bariatric surgeries; thus, they need skilled professional surgeons for better evaluation of the condition, reviewing of the case, determination of causes of failure of the previous procedure, and putting in place the most appropriate management plan to achieve the best outcome. Objectives We present here a case of a 56-year-old gentleman known to have uncontrolled diabetes mellitus, hypertension, osteoarthritis, and dyspnoea grade 3. The patient has morbid obesity with a starting weight of 160 kg (BMI ∼56.7 kg/m2) and underwent an adjustable gastric band with weight gain reaching 189 kg in 4 years with no improvement in diabetic status. The patient went for RYGB as a revisional surgery after the removal of the band with good weight loss and better control of the diabetic status, but the patient developed severe attacks of dumping symptoms that failed to improve with medical treatment, lifestyle modification, and even after open proximal alimentary diversion surgery. The patient presented to our facility with 134 kg (BMI ∼47.5 kg/m2) and underwent laparoscopic conversion RYGB to sleeve gastrectomy. Methods Laboratory and imaging investigations were done, including MSCT gastric volumetry, which revealed a gastric pouch size of 50–75 cm with a hiatus hernia. Laparoscopic sleeve gastrectomy was done after resection of the gastrojejunostomy part, anastomosis between the alimentary and biliopancreatic limbs as a restoration of GI continuity and dismantling of the previous jejunojejunostomy. Results The patient was discharged POD2, following uneventful recovery on clear fluids, full fluids, a soft diet, and a regular diet, each for 5 days, respectively. The patient was put on a nutritional plan, including a diet plan, supplements, and multivitamins. Follow-up monthly revealed significant improvement in the dumping symptoms, improvement of the diabetic status, and relative improvement in weight loss (109 kg, BMI∼38.6 kg/m2). Conclusion LSG after RYGB is a tedious procedure, with only a few cases found in the literature.