Gastric bypass with weight regain – Biliary limb distalization plus endoscopic transjejunal A.P.C. pouch therapy in one step: Case report

INTRODUCTION: In recent years there has been a significant growth in the percentage of patients with weight regain after Roux-en-Y gastric bypass (RYGB). Approximately 20% RYGB patients may experience weight regain 24 months after the intervention. PRESENTATION OF CASE: A 53 yr male patient who underwent RYGB in 2011 with an initial weight of 140 kg and BMI of 44.19 kg/m who consults in 2019 for a weight regain of 45.9%. Transoperative endoscopy assessment revealed a gastric pouch and gastrojejunal anastomosis with a diameter of 7 cm and 2.5 cm respectively. During the procedure we found a common channel of 725 cm, it is decided to shorten it through the distalization of the biliopancreatic limb. Afterward using the same laparoscopic ports to introduce the endoscope through jejunal cane to realize the APC therapy. He was discharged on the 2nd-day, without any complaint. DISCUSSION: The purpose of this case report is to expose the viability to perform a combined surgical technique such as the distalization of the biliopancreatic limb with endoscopic techniques of argon plasma coagulation (APC) via transjejunal in the same operative course. Using this combined technique we can increase hypoabsortive and restrictive components that would represent a secure and efficient weight loss in our patient. CONCLUSIONS: This innovative technique can represent a viable alternative that is secure and reproducible in revisional surgery for weight regain context.