# Functional Reversal as a Feasible Option for Malnutrition in Patients With Hyper-Response Following Roux-en-Y Gastric Bypass: A Case Report

## TL;DR

A patient with severe malnutrition after gastric bypass surgery improved through a functional reversal procedure, which may be a safer option than full reversal.

## Contribution

This case report introduces functional reversal as a less complex and lower-risk surgical option for malnourished patients post-Roux-en-Y gastric bypass.

## Key findings

- Functional reversal of RYGB led to resolution of nutritional deficiencies in a malnourished patient.
- Functional reversal is technically less complex and potentially safer than full anatomical reversal.
- The patient showed clinical improvement after one month of mixed nutrition and surgery.

## Abstract

Obesity is recognized as a global epidemic, and bariatric surgery is the most effective treatment for obesity and its associated comorbidities, providing durable long-term outcomes. However, a subset of patients develops malnutrition as a complication despite adequate nutritional supplementation, for whom revisional surgery may be indicated, although such procedures can be technically and clinically challenging.

We discuss the case of a 55-year-old female with a significant surgical history, including three cesarean sections and a fundoplication performed 17 years earlier, who underwent Roux-en-Y gastric bypass (RYGB) at a private hospital. At the time of bariatric surgery, her weight was 107 kg, with a BMI of 41.7 kg/m² and a height of 1.60 m. One year and nine months postoperatively, she presented to our center for the first time, reporting generalized weakness, asthenia, and reduced physical activity, despite adherence to prescribed nutritional supplementation and dietary recommendations. After a complete assessment and laboratory tests identifying normocytic normochromic anemia and severe malnutrition (albumin 2.5) and one month of mixed nutrition, we performed revisional surgery with functional reversal of RYGB with later resolution of her nutritional deficiencies.

The RYGB reversal using Gastro-gastric anastomosis (functional reversal) appears to be a feasible, less complex option with a potentially lower complication risk than full anatomical reversal in malnourished RYGB patients.