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

## TL;DR

A patient with persistent bile reflux after gastric bypass surgery found relief through a revisional surgical procedure, highlighting its effectiveness in such cases.

## Contribution

Demonstrates the efficacy of laparoscopic Roux-en-Y gastric bypass in managing refractory bile reflux following One-Anastomosis Gastric Bypass.

## Key findings

- Conversion to LRYGB provided total symptom relief and nutritional recovery in a patient with persistent bile reflux.
- Recurrent hiatal hernia may exacerbate bile reflux after OAGB and should be evaluated.
- LRYGB prevents esophageal damage by segregating biliopancreatic secretions.

## Abstract

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.

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.

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.

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.

•Persistent bile reflux after OAGB is hard to treat with medical or intermediate surgical options.•This case illustrates the success of entero-enteric diversion to resolve bile reflux symptoms post-OAGB.•Recurrent hiatal hernia may worsen bile reflux after OAGB and should be assessed.•LRYGB should be considered for refractory bile reflux to prevent esophageal damage.

Persistent bile reflux after OAGB is hard to treat with medical or intermediate surgical options.

This case illustrates the success of entero-enteric diversion to resolve bile reflux symptoms post-OAGB.

Recurrent hiatal hernia may worsen bile reflux after OAGB and should be assessed.

LRYGB should be considered for refractory bile reflux to prevent esophageal damage.