Surgical Management of Small Intestinal Bacterial Overgrowth After Roux-en-Y Gastric Bypass

Abstract

Introduction

Small intestinal bacterial overgrowth (SIBO) is a common adverse effect after laparoscopic Roux-en-Y gastric bypass (LRYGB) and may be responsible for chronic diarrhea, abdominal pain, and discomfort. Although its pathophysiology is still unclear, surgical management may be appropriate in selected cases.

Methods

In this video, we present a surgical revision of LRYGB, 12 years after the initial surgery, for late postoperative chronic diarrhea. The diagnosis of SIBO was finally established and associated with a dilated jejuno-jejunostomy diagnosed through a small bowel follow-through.

Results

Revision of the RYGB was performed by resecting the dilated jejunostomy and fashioning a new one with a shorter Roux-en-Y limb. During follow-up, the patient showed fast improvement and complete resolution of symptoms was obtained at 12 months.

Conclusion

SIBO may be responsible for postoperative chronic diarrhea in RYGB patients, possibly in the long term, and it is often misdiagnosed. Primary treatment is conservative with appropriate dietary measures, antibiotics, and probiotics but surgical management can be very effective in selected patients presenting with failure of prolonged medical treatment and an anatomic abnormality.

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Correspondence to Antonio Iannelli.

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The authors declare that they have no conflicts of interests.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Alcaraz, F., Frey, S. & Iannelli, A. Surgical Management of Small Intestinal Bacterial Overgrowth After Roux-en-Y Gastric Bypass. OBES SURG 30, 4677–4678 (2020). https://doi.org/10.1007/s11695-020-04809-5

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Keywords

  • Bariatric surgery
  • Roux-en-Y
  • Gastric bypass
  • Morbid obesity
  • Bacterial overgrowth