PMC4802335_01
Panel a depicts the entero-entero anastomosis (OEE) and the gastro-jejunostomy after Roux-en-Y gastric bypass. Panel b demonstrates the division of the alimentary limb 6 cm below the gastro-jejunostomy and the anastomosis of the proximal part of the alimentary limb to the gastric remnant. A new entero-entero anastomosis is made between the former alimentary and bilio-pancreatic limb following transection of the original entero-entero anastomosis at the bilio-pancreatic limb side. A is previously published in D. Hofso et al.: Follow-up after bariatric surgery, in the Journal of the Norwegian Medical Association, 2011, by permission from K. Toverud, CMI. B was produced for our paper by K. Toverud, CMI. The images are not covered by the terms of the Creative Commons licence of this publication. For permission to reuse, please contact the rights holder (K. Toverud, CMI).
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A 37-year-old man (weight 183 kg, height 185 cm, BMI 53.5 kg/m2) with known bradycardia, asthma and gout, but no diabetes, had a laparoscopic RYGB with a 150 cm (antecolic) alimentary and a 50 cm bilio-pancreatic limb (Fig. 1a). The patient was finally offered a modified reversal of the RYGB (Fig. 1b). During laparoscopy the gastrostomy tube was removed and the alimentary limb was transected 6 cm below the gastro-jejunostomy (Fig. 1b).