UNRAVELLING
A COMPLICATION

Sleeve Gastrectomy complications corrected with
Roux-en-Y Gastric Bypass

A 31-year-old woman, weighing 130 kgs with a BMI of 42.6 kg/m2, underwent a Sleeve Gastrectomy procedure. Immediately post surgery, she complained of nausea and vomiting, which is common for a few days post any Bariatric Surgery. After her discharge, she came back within 2 days with complaints of persistent nausea, vomiting and abdominal pain. She underwent a CT scan, which showed oral contrast was not passing down into the duodenum, indicative of Gastric Outlet Obstruction.

An Upper GI endoscopy was done, which showed a twist in the stomach (Gastric Torsion) at the level of the Incisura Angularis. This is an extremely rare complication post



The Laparoscopy was ineffective and we then had to convert the Sleeve Gastrectomy to a Roux-en-Y Gastric Bypass. The CT scan post Roux-en-Y Gastric Bypass showed a smooth passage of oral contrast down into the jejunum. After almost 11 days of starving since the 1st surgery, the patient was finally able to tolerate all food orally.

Sleeve Gastrectomy. The patient, then underwent an emergency Laparoscopy, wherein the experts at Nanavati Super Speciality Hospital stapled across the torsion site, similar to a Stricturoplasty.

However, there was no considerable improvement. Subsequently, Sleeve Gastrectomy was converted to a Rouxen-Y Gastric Bypass. The CT scan post Roux-en-Y Gastric Bypass showed a smooth passage of oral contrast down into the jejunum. After almost 11 days of starving since the first surgery, the patient was finally able to tolerate all food orally.

Though complications are rare post Bariatric Surgery, it is important to be alert, and have enough clinical experience to diagnose and treat them appropriately and well in time.