title: Laparoscopic Conversion of One Anastomosis Gastric Bypass to Roux-en-Y Gastric Bypass for Chronic Bile Reflux.
abstract: BACKGROUND
  One anastomosis gastric bypass (OAGB) demonstrated similar results to traditional Roux-en-Y procedures. A possible concern is how to manage a chronic bile reflux when medical therapy results ineffective. Revision of the gastro-jejunal anastomosis, obtaining a Roux-en-Y reconstruction, has already been proposed, but technical details have not been elucidated yet. This video shows how to revise a 200-cm OAGB to treat chronic bile reflux, by converting the procedure to Roux-en-Y, having a short gastric pouch and a long efferent limb.
  
  
  METHODS
  A 51-year-old patient complained of recurrent heartburns 2 months after OAGB. A gastroscopy witnessed the presence of a 6-cm long gastric pouch with pouchitis and bile reflux in esophagus. Specific medications were ineffective. He underwent a revisional laparoscopic procedure. The efferent limb was measured and consisted of 650 cm. The afferent limb was then divided next to the previous gastro-jejunal anastomosis and a jejuno-jejunal anastomosis was performed distally at 70 cm on the alimentary limb.
  
  
  RESULTS
  Total operative time was 50 min. The postoperative stay was uneventful and the patient was discharged in postoperative day four. At 6 months follow-up he is still free of medications without symptoms.
  
  
  CONCLUSIONS
  The ideal scenario for the presented technique is the finding of a long efferent limb, in order to fashion a Roux-en-Y limb without the risk of postoperative malabsorption. To reach this goal, we suggest the measurement of the whole small bowel intra-operatively, in order to assess the length of the common channel left in place.
authors.affiliation: Department of Surgery, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, Piazza Santa Maria Nuova, 50122, Florence, Italy. enricofacchiano@yahoo.it.
authors.forename: Enrico
authors.initials: E
authors.lastname: Facchiano
authors.affiliation: Department of Surgery, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, Piazza Santa Maria Nuova, 50122, Florence, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Leuratti
authors.affiliation: Department of Surgery, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, Piazza Santa Maria Nuova, 50122, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Veltri
authors.affiliation: Department of Surgery, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, Piazza Santa Maria Nuova, 50122, Florence, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Lucchese
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D001655:Bile Reflux / Q000601:surgery*; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D016896:Treatment Outcome
keywords: Bariatric surgery; Complication; Laparoscopy; Mini gastric bypass; Obesity; One anastomosis gastric bypass; Revisional procedure; Roux-en-Y gastric bypass