# Candy Cane Limb Revision After Roux-en-Y: A Four-Patient Case Series

## TL;DR

This paper presents four cases of candy cane syndrome after gastric bypass surgery and shows that robotic-assisted revision surgery effectively resolves symptoms.

## Contribution

The study contributes a case series demonstrating the effectiveness of robotic-assisted surgery for treating candy cane syndrome.

## Key findings

- Robotic-assisted revision surgery resolved symptoms in all four patients with candy cane syndrome.
- Postoperative follow-up showed no recurrence of symptoms and improved quality of life.
- Endoscopy and contrast imaging were key in diagnosing the condition.

## Abstract

Candy cane syndrome is an uncommon yet clinically significant complication of Roux-en-Y gastric bypass surgery, causing symptoms such as nausea, vomiting, dysphagia, abdominal pain, and persistent gastrointestinal discomfort. These symptoms arise from a redundant afferent Roux limb near the gastrojejunostomy, which causes food stasis and mechanical irritation. Diagnosis can be challenging, as symptoms frequently mimic other common postoperative complications, necessitating careful evaluation through advanced imaging studies and endoscopic assessments. It is most effectively established through upper endoscopy and contrast imaging, both of which can reveal the blind limb segment. When identified, surgical resection of the redundant limb provides a reliable means of symptom resolution. Robotic-assisted revisional surgery facilitates precise dissection and improved visualization, resulting in favorable outcomes. Preventive measures during the initial bypass include appropriate measurement and orientation of the Roux limb and meticulous inspection of the anastomosis.

In this case series, we present four patients diagnosed with candy cane syndrome, illustrating a spectrum of clinical presentations, diagnostic approaches, and surgical revisions. All four patients underwent robotic-assisted revisional surgery that involved precise resection of the redundant Roux limb with reconstruction of the gastrojejunal anastomosis. Postoperative follow-up demonstrated complete resolution of symptoms, significant improvement in quality of life, and no recurrence of symptoms at the time of manuscript preparation.