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

Authors

Andres Fontaine-Nicola, Department of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, San Diego, CA, USA. Electronic address: afontainenicola@health.ucsd.edu.
Paula Cambuli-Bianchi, Department of Surgery, Division of Esophageal, Gastroduodenal and Bariatric Surgery, Italian Hospital of Mendoza, Mendoza M5519, Argentina.
Kaiser O'Sahil Sadiq, Department of Surgery, George Washington University, Washington, DC, USA.
Gabriel Carrizo, Department of Surgery, Division of Esophageal, Gastroduodenal and Bariatric Surgery, Italian Hospital of Mendoza, Mendoza M5519, Argentina.
Pablo Omelanczuk, Department of Surgery, Division of Esophageal, Gastroduodenal and Bariatric Surgery, Italian Hospital of Mendoza, Mendoza M5519, Argentina.

Document Type

Journal Article

Publication Date

8-1-2025

Journal

International journal of surgery case reports

Volume

133

DOI

10.1016/j.ijscr.2025.111642

Keywords

Bile reflux; Conversion surgery; One-anastomosis gastric bypass; Roux-en-Y gastric bypass

Abstract

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.

APA Citation

Fontaine-Nicola, Andres; Cambuli-Bianchi, Paula; Sadiq, Kaiser O'Sahil; Carrizo, Gabriel; and Omelanczuk, Pablo, "Refractory bile reflux following one-anastomosis gastric bypass: A case report and literature review on surgical management" (2025). GW Authored Works. Paper 7524.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7524

Department

School of Medicine and Health Sciences Resident Works