# Emergency Laparoscopic Reversal of One‑Anastomosis Gastric Bypass Following Early Anastomotic Failure: Video Case Report of Management

## TL;DR

This case report describes an emergency reversal of a gastric bypass surgery due to an early leak, offering a rare example of this approach with a video.

## Contribution

The paper provides a detailed video case report of an emergency OAGB reversal, filling a gap in the literature.

## Key findings

- Emergency reversal of OAGB can serve as a salvage option when re-anastomosis or conversion to RYGB is unfeasible.
- The patient recovered well post-reversal and was discharged in good condition.
- Operative video and detailed reporting offer a rare insight into managing early OAGB leaks.

## Abstract

One anastomosis gastric bypass (OAGB) is the third most common metabolic bariatric surgery. Early anastomotic failure is uncommon and may necessitate re-operation. The most common re-operative strategy is peritoneal washout and drainage, while the preferred reconstructive approach is conversion to Roux-en-Y gastric bypass (RYGB). Reversal to normal anatomy in this emergency setting is extremely rare. We present a detailed single-patient emergency OAGB reversal for a leak with operative video, addressing a gap in the published literature.

A 28‑year‑old woman with BMI 36.2 kg/m² without comorbidities underwent laparoscopic OAGB. Two weeks later, she presented with abdominal pain, nausea, and vomiting. Computerized tomography (CT) demonstrated free air and perianastomotic fluid without contrast extravasation. Laparoscopy revealed anastomotic dehiscence with murky bile-stained fluid largely walled off by the liver. After taking down the anastomosis, a markedly distended gastric remnant prevented RYGB reconstruction. As the patient became unstable, reversal of OAGB was performed as a salvage procedure. Post‑operatively she required intensive care and parenteral nutrition. An intraluminal drain–related leak was diagnosed and managed endoscopically by drain repositioning. She resumed oral intake gradually and was discharged in good condition. At two weeks she tolerated a soft diet. At six months she reported intermittent vomiting with solids, though CT and endoscopy were unremarkable and symptoms improved with dietary modification.

Early anastomotic dehiscence after OAGB may require urgent surgical intervention. When re‑anastomosis or conversion to RYGB is unfeasible and the patient is unstable, reversal to normal anatomy can serve as a salvage option.

The online version contains supplementary material available at 10.1007/s11695-026-08492-w.

Early OAGB leaks are rare; most operated cases undergo lavage or conversion to RYGB.

Emergency reversal is a viable salvage option when other strategies are not feasible.

Emergency OAGB reversal for an acute leak is exceptionally uncommon.

We fill a gap in literature with a detailed single-patient report with operative video.

The online version contains supplementary material available at 10.1007/s11695-026-08492-w.