Double tract reconstruction for the management of small intestinal bacterial overgrowth after Roux-en-Y gastric bypass

Abstract Introduction: Small intestinal bacterial overgrowth (SIBO) after Roux-en-Y gastric bypass (RYGB) is underdiagnosed and its management is challenging. Double tract after RYGB may decrease malabsorption and intestinal stagnation. We report our experience, as an innovative approach by using double tract reconstruction for the management of SIBO after RYGB. Patients and Methods: All patients included underwent a double tract reconstruction after RYGB for obesity between January 2020 and December 2023. Double tract reconstruction was only indicated after a documented positive breath test, failure of conservative treatment and exclusion of a candy-cane effect or a very long biliopancreatic limb. Body mass index, reflux and SIBO symptoms were recorded. Results: Five patients were included. All patients had an uneventful post-operative course. Median length of hospital stay was 2 days. All patients had a significant improvement in their symptoms at the first post-operative appointment. At the end of follow-up, two patients had no improvement in symptoms, while three patients had significant improvement. Among them, two patients were completely cured from chronic diarrhoea. No patient reported weight regain or reflux symptoms. Conclusion: Double tract reconstruction might be a safe and reproductive procedure, which should be considered in patients with SIBO after RYGB whose medical treatment has failed.