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Background

Patients who have undergone gastric sleeve operations may experience expected complications, but when severe gastroesophageal reflux cannot be medically managed and the patient's quality of life is hindered, surgical intervention is indicated.

Methods

We present the case of a 75-year-old female that underwent a sleeve gastrectomy converted to duodenojejunostomy in 2018 that caused the patient to have unrelenting gastric reflux that would later worsen to frequent bilious emesis, sleep and eating disturbances due to epigastric discomfort, and incidences of bronchiectasis and atelectasis. Pre-operative investigation revealed a small hiatal hernia, diffuse esophageal dilation, and pathology of the antrum of the stomach showed chronic gastric with no microorganisms. Intraoperatively, the prior anastomosis appeared to be functional with minimal surrounding adhesions. A new anastomosis of the biliopancreatic and alimentary limb was then performed 100 cm to the single duodenojejunostomy was then performed. Upon visualization of extensive adhesions associated with the hiatal hernia, repair was aborted as the bowel had already been diverted distally.

Results

The patient tolerated the surgery well, was discharged on post-operative day two, and during her two week follow-up, she endorsed relief of all prior symptoms related to the surgery and denied any complications.

Conclusions

Although symptoms that present secondary to a prior surgery may often be medically managed and multiple abdominal surgeries come with potential complications, surgical interventions such as a re-anastomosis can be pursued in a safe way that improve the patient's outcome.