Refractory bile reflux following one-anastomosis gastric bypass: A case report and literature review on surgical management.

INTRODUCTION

Bile reflux is a recognized complication of One-Anastomosis Gastric Bypass (OAGB). Its management can be challenging, particularly when symptoms persist despite medical therapy or surgical diversion.

CASE PRESENTATION

A 46-year-old woman developed persistent bilious vomiting, nocturnal regurgitation, and aspiration following OAGB. Preoperative imaging indicated gastroesophageal reflux and a recurrent hiatal hernia. The patient underwent conversion to laparoscopic Roux-en-Y gastric bypass (LRYGB) due to her persistent symptoms and related nutritional impairment. Postoperative follow-up indicated total symptom relief and nutritional recovery thanks to the creation of the entero-enteric anastomosis.

DISCUSSION

This case illustrates the outstanding efficacy of entero-enteric diversion in specific individuals and emphasizes the importance of LRYGB in addressing refractory bile reflux, especially in the presence of anatomical considerations like hiatal hernia. The anatomical alteration of LRYGB provides functional segregation of biliopancreatic secretions, inhibiting their reflux into the esophagus.

CONCLUSION

Converting to LRYGB effectively addresses chronic biliary reflux following OAGB. In analogous situations, the evaluation of revisional surgery may save further esophageal injury and enhance quality of life.