Reversal of Roux-en-Y anatomy via gastrogastric anastomosis and sleeve gastrectomy for refractory early dumping syndrome: a case report

Early dumping syndrome (DS) is a common complication after Roux-en-Y gastric bypass (RYGB), with refractory cases posing significant therapeutic challenges. A 38-year-old male developed severe refractory early DS 2 years post-RYGB, confirmed by modified oral glucose tolerance test meeting Scarpellini 2020 criteria. Symptoms persisted despite maximal dietary and pharmacotherapy (acarbose, somatostatin analogues). The patient underwent laparoscopic gastrogastric anastomosis combined with sleeve gastrectomy -the first reported application for this indication. The Sigstad score decreased from 16 to 6 at 180-day follow-up, indicating complete symptom resolution. Endoscopy and imaging confirmed patent anastomosis without stenosis/leakage, and no complications occurred. This novel combined procedure is a safe and effective solution for refractory early DS post-RYGB, restoring physiological gastric emptying. Long-term outcomes require validation in larger studies.