Double Roux-en Y Configuration for Managing Chronic Leak After Conversional Roux-en Y Gastric Bypass.

Staple line leak is one of the most critical complications after metabolic and bariatric surgery (MBS). In chronic cases, definitive surgical reconstruction remains the treatment of choice. We report the case of a 24-year-old female with a history of sleeve gastrectomy (SG), converted to Roux-en-Y gastric bypass (RYGB) 2 days later due to a gastroesophageal junction (GEJ) leak. Postoperatively, she developed a left subdiaphragmatic collection requiring percutaneous drainage. One year later, due to recurrent symptoms, left subdiaphragmatic abscess and a fistulous tract between the collection and the gastric pouch on CT scan, surgical intervention was performed, including fistulojejunostomy using a new Roux-en-Y limb at the leak site. At 6-month follow-up, the patient remained without complication. The double Roux-en-Y (RY) configuration, involving the creation of an end-to-side RY fistulojejunostomy, can be an effective and feasible surgical option.