Background

Reversal of Roux-en-Y gastric bypass is occasionally required for ongoing complications in select cases. Most commonly, reversals are performed for refractory malnutrition, excessive weight loss, intractable post prandial hypoglycemia, or dumping syndromes. Additional indications include non-healing/recurrent marginal ulcers and efferent blind loop syndromes (“Candy cane syndrome”) in circumstances where simple gastrojejunostomy revision is not appropriate. We review laparoscopic reversal of a prior Roux-en-Y gastric bypass. The patient is a 47-year-old female active smoker who presented thirteen years after her original operation suffering from continued refractory pain, nausea, vomiting and excessive weight loss with a BMI of 18. Her Surgical history is notable for a prior open total abdominal colectomy for colonic inertia and pelvic floor reconstruction. Preoperative workup included upper endoscopy, an upper GI series as well as an oral contrast enhanced CT which ultimately revealed preferential filling and distension of an inappropriately long (4cm) blind proximal roux limb (“candy cane syndrome”). This finding, concomitant with her excessive weight loss and smoking status, led to the recommendation for reversal. The operation was uncomplicated and normal anatomy was restored (video). Her recovery was uneventful and she was discharged home on post-operative day six. One month follow up has also been uncomplicated and she reports total resolution of her preoperative symptoms. Her excessive weight loss has also improved with a BMI of 20 and pre-albumin of 26.