Pandora’s Box: Unpredictable Evolution of a 20-Year History of a Bariatric Patient—Report of Small Bowel Migrated Gastric Band after Redo Banded Gastric Bypass

Excerpt

Bariatric surgery is the most effective treatment for morbid obesity, with excellent long-term results on weight loss, comorbidities, and quality of life (QoL) [1]. However, complications due to surgical technique, surgeons’ experience, patient’s compliance, and lack of availability of multidisciplinary follow-up have resulted in failure in 10–20% cases [2]. Standard RY gastric bypass (GBP) is considered the “gold standard” [3] even if sleeve gastrectomy (LSG) has gained worldwide supremacy as the most performed bariatric surgery procedure [4]. In case of failure (weight regain (WR) or insufficient weight loss IWL) due to dilatation of isolated gastric pouch and/or wide gastro-jejunal anastomosis, several other options have been proposed: endoscopic/surgical re-size of the pouch or anastomosis, banding the isolated gastric pouch (with different rings or bands), conversion to distal GBP or more malabsorbative procedures [5]. All these redo procedures seem to be safe with limited long-term follow-up [6‐8]. In a recent systematic review, Mawar et al. showed that primary banded GBP (PBRYGBP) is an attractive bariatric procedure with superior weight loss that is best demonstrated in super-obese patients [7], associated with specific complication rates like migration in up to 2% of the cases. We herein present a case of a 58-year-old morbid obese female patient having a history of over 20 years of bariatric endo-laparoscopic treatment. …