Pandora's box: unpredictable evolution of a 20-year history of a bariatric patient-report of small bowel migrated gastric band after redo banded gastric bypass

Introduction: morbid obesity is a chronic disease, with resistance to multiple therapies. Bariatric surgery is the most efficient nowadays treatment, but with a certain price when we speak of surgeon’s efforts, patient’s compliance and tolerance, available technology and long term evolution. Materials: we present the case of 20 years evolution of a female obese patient, with multiple, sequential bariatric minimally-invasive interventions: intragastric balloon, gastric banding, gastric bypass (GBP), banding positioning on GBP, all complicated. Last attempt to treat weight regain was laparoscopic positioning of an adjustable banding over a failed gastric bypass in 2015, complicated 12 months after by acute intestinal occlusion due to band migration, leading to open emergency band removal, wound dehiscence and finally incisional hernia. Results: after multiple interventions, the patient has a BMI of 38 kg/m2, large incisional hernia, depression, over a non-satisfactory gastric bypass. Conclusion: bariatric surgery has some limitations in case of patient’s non-compliance and bad-luck, even with persistent, experienced tailored bariatric treatment. Non-responsive obese patients should be considered as possible subcategory of long-term outcomes.