The 15-cm Roux Limb: a Technical Misadventure

Despite effectively treating obesity and its comorbidities, only a fraction of the growing obese population is evaluated for bariatric surgery. Aside from barriers including resources and social support, patients report personal experience with friends and relatives suffering poor outcomes after bariatric surgery. Rates of mortality, leaks, and strictures have decreased over the past 20 years, but few instances of gross surgeon error have been reported in the literature. Our objective is to report and demonstrate the revision of a critically shortened Roux limb in a patient with chronic nausea and dysphagia found to have a 15-cm Roux limb and briefly discuss its implications.

We performed a successful laparoscopic revision of this patient’s previous Roux-en-Y gastric bypass, with creation of a 125-cm Roux limb.

Total operative time was 87 min, there were no major intraoperative complications, and the post-operative course was unremarkable. At one-month follow-up, the patient reported complete resolution of all prior symptoms. At three-month follow-up, BMI decreased from 37 prior to revision to 31.

Reducing complications and improving quality of care will support the necessary growth of bariatric surgery. Standards set forth by accreditation bodies such as the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) assist in this endeavor, and technical errors, though difficult to evaluate, should be monitored.