Surgical Management of Small Intestinal Bacterial Overgrowth After Roux-en-Y Gastric Bypass

  • PDF / 180,862 Bytes
  • 2 Pages / 595.276 x 790.866 pts Page_size
  • 93 Downloads / 140 Views

DOWNLOAD

REPORT


MULTIMEDIA ARTICLE

Surgical Management of Small Intestinal Bacterial Overgrowth After Roux-en-Y Gastric Bypass Florent Alcaraz 1,2 & Sebastien Frey 1,2 & Antonio Iannelli 1,2,3,4

# Springer Science+Business Media, LLC, part of Springer Nature 2020

Abstract Introduction Small intestinal bacterial overgrowth (SIBO) is a common adverse effect after laparoscopic Roux-en-Y gastric bypass (LRYGB) and may be responsible for chronic diarrhea, abdominal pain, and discomfort. Although its pathophysiology is still unclear, surgical management may be appropriate in selected cases. Methods In this video, we present a surgical revision of LRYGB, 12 years after the initial surgery, for late postoperative chronic diarrhea. The diagnosis of SIBO was finally established and associated with a dilated jejuno-jejunostomy diagnosed through a small bowel follow-through. Results Revision of the RYGB was performed by resecting the dilated jejunostomy and fashioning a new one with a shorter Roux-en-Y limb. During follow-up, the patient showed fast improvement and complete resolution of symptoms was obtained at 12 months. Conclusion SIBO may be responsible for postoperative chronic diarrhea in RYGB patients, possibly in the long term, and it is often misdiagnosed. Primary treatment is conservative with appropriate dietary measures, antibiotics, and probiotics but surgical management can be very effective in selected patients presenting with failure of prolonged medical treatment and an anatomic abnormality. Keywords Bariatric surgery . Roux-en-Y . Gastric bypass . Morbid obesity . Bacterial overgrowth

Introduction While obesity is becoming prevalent throughout developed countries, bariatric surgery offers one of the most effective treatments in long-term outcomes [1]. Over time, laparoscopic Roux-en-Y gastric bypass (LRYGB) has become the most performed procedure along with sleeve gastrectomy (SG) Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04809-5) contains supplementary material, which is available to authorized users.

[2]. Although they have the best results in terms of excess weight loss (EWL) and the resolution of obesity-related comorbidities, postoperative morbidity may be invalidating. Late postoperative diarrhea following LRYGB is not uncommon and is often underestimated and regularly seen as a “normal” symptom after LRYGB by physicians and patients [3]. Small intestinal bacterial overgrowth (SIBO) should be considered in the differential diagnosis of diarrhea in this setting [4]. The aim of this video is to present the surgical management of SIBO following LRYGB where medical therapy had failed.

* Antonio Iannelli [email protected]

Methods 1

Université Côte d’Azur, Nice, France

2

Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet 2, Centre Hospitalier Universitaire de Nice, Nice, France

3

Inserm, U1065, Team 8 “Hepatic complications of obesity and alcohol”, Nice, France

4

Department of Digestive Surgery, Archet 2 Hospital, Unive