Gastric bypass is redemption after failed bariatric procedures. A video report on a complicated sleeve gastrectomy in a multiple operated patient

Introduction: Laparoscopic sleeve gastrectomy is the most performed bariatric procedure, but complications might interfere with patient’s long-term evolution based on patient’s compliance and tolerance, surgical attitude and unpredictable evolution. Materials: We present the case of a female obese patient, with impaired type II diabetes mellitus and other comorbidities, with multiple, sequential bariatric minimally-invasive interventions: sleeve gastrectomy in 2012 complicated by postoperative acute gastric dilation and later by mediogastric stenosis, with endoscopic gastric dilations; reoperated for viscerolysis and cholecystectomy; initially converted to functional one anastomosis gastric bypass (200 cm limb), with a non-adjustable gastric ring positioned instead of stapled division. The last operation was complicated 12 months after by persistent biliary gastro-esophageal reflux, chronic abdominal pain, and gas bloat syndrome. In 2018 the patient underwent conversion to laparoscopic R-en-Y gastric bypass, with gastro-enteral anastomosis resection, band removal and viscerolysis. Results: Conversion to R-en-Y was complicated by biliary leakage post-viscerolysis, treated with laparoscopic approach in the 9thpo day. After multiple surgical and endoscopic interventions, the patient presents short-term favorable outcomes, with no reflux or abdominal pain, with further weight loss and diabetes improvement. Conclusion: Bariatric surgery has unpredictable evolution in same cases, and conversion to R-en-Y seems to be the best solution.