Successful Mini Gastric Bypass for Morbid Obesity in a 36 Y.O. Male After Sleeve Gastrectomy

Chief Complaints

A 36-year-old male patient with a body mass index (BMI) of 40.04 presented to the Bariatric and Metabolic Surgery Department at PACE Hospitals, Hitech City, Hyderabad, seeking revision metabolic surgery due to significant weight regain over the previous two years following sleeve gastrectomy.

The patient had undergone laparoscopic sleeve gastrectomy in the past for morbid obesity and achieved satisfactory initial weight loss. However, gradual weight regain occurred during the previous two years. He had no known history of diabetes mellitus, hypertension, cardiovascular disease, or other significant medical illnesses. There was no history of complications related to the previous bariatric surgery, and he had no known drug allergies.

On examination, the patient was conscious, coherent, oriented, and hemodynamically stable. His BMI was 40.04 kg/m², consistent with morbid obesity. Systemic examination revealed no acute abnormalities. Abdominal examination was soft, non-tender, and without organomegaly or signs of previous surgical complications. The remaining systemic examination was within normal limits.

Upon admission to PACE Hospitals, following a detailed clinical assessment, the Bariatric and Metabolic Surgery team evaluated the patient for weight regain following previous sleeve gastrectomy, along with a review of his relevant past medical and surgical history.

Clinical examination revealed findings consistent with morbid obesity (BMI 40.04 kg/m²) following previous sleeve gastrectomy, which was primarily established based on history and physical examination findings suggestive of significant weight regain after the initial bariatric procedure.

Routine investigations, including complete blood picture, serum electrolytes, renal function tests, liver function tests, blood glucose levels, electrocardiogram (ECG), and pre-anaesthetic (PAC) evaluation, were performed as part of the preoperative evaluation to assess the patient's general medical status. These investigations were largely within acceptable limits and served as supportive assessments rather than definitive diagnostic tools.

Based on the confirmed diagnosis, the patient was advised to undergo Morbid Obesity Treatment in Hyderabad, India, under the expert care of the Bariatric and Metabolic Surgery Department.

After detailed consultation with Dr. Suresh Kumar S (Surgical Gastroenterologist and Bariatric Surgeon), a comprehensive evaluation was performed to determine the most appropriate diagnostic and therapeutic approach.

Considering the patient's history of previous sleeve gastrectomy performed in the past, significant weight regain over the past two years, and persistent, morbid obesity (BMI 40.04 kg/m²), further evaluation confirmed inadequate long-term weight loss following the primary bariatric procedure. Routine laboratory investigations revealed stable hematological, renal, hepatic, and electrolyte parameters, confirming the patient's suitability for revision metabolic surgery.

Based on clinical assessment and routine laboratory investigations showing stable parameters, it was determined that laparoscopic sleeve conversion to mini gastric bypass (MGB) under general anaesthesia was the most appropriate and effective management strategy. This approach was chosen to create a smaller gastric pouch and reroute a portion of the small intestine, thereby promoting sustained weight loss, improving metabolic function, reducing the risk of further weight regain, and achieving better long-term bariatric outcomes.

The patient and his family members were counselled regarding the diagnosis, clinical findings, planned procedure, expected benefits, potential risks, postoperative dietary modifications, lifelong nutritional supplementation, and the importance of postoperative care and regular follow-up.

Following the decision, the patient was scheduled for Laparoscopic Sleeve Conversion to Mini Gastric Bypass (MGB) in Hyderabad at PACE Hospitals, under the expert care of the Bariatric and Metabolic Surgery team.

The following steps were carried out during the procedure:

• Patient Preparation and Anaesthesia: Following complete preoperative evaluation and anaesthetic clearance, the patient was taken up for surgery under general anaesthesia. After appropriate positioning and sterile preparation, laparoscopic access was established.

• Assessment of Previous Sleeve Anatomy: The previously created gastric sleeve was carefully evaluated laparoscopically. Adhesions, if present, were released carefully to facilitate safe revision surgery.

• Creation of Gastric Pouch: A small proximal gastric pouch was created from the existing sleeve stomach while preserving adequate blood supply. This reduced gastric reservoir was designed to improve long-term restrictions.

• Mini Gastric Bypass Reconstruction: A loop of the small intestine was identified and brought up to the newly created gastric pouch. A gastrojejunostomy was performed to establish the mini gastric bypass, allowing food to bypass a portion of the stomach and upper small intestine.

• Hemostasis and Completion: The anastomosis and operative field were inspected carefully for bleeding and leakage. Adequate hemostasis was achieved, and the procedure was completed laparoscopically without intraoperative complications.

The patient had an uneventful postoperative recovery and remained hemodynamically stable throughout the hospital stay. He was closely monitored for postoperative complications and received supportive treatment for infection prevention, pain control, gastric protection, and maintenance of hydration. Early ambulation was encouraged to reduce the risk of thromboembolic complications. The patient developed postoperative urinary retention, which was managed with Foley catheterization, and a phased liquid diet was initiated to support healing and recovery.

Upon discharge, the patient was prescribed medications for pain relief, protection of the gastric pouch by reducing acid secretion, prevention of postoperative blood clot formation, and lifelong nutritional supplementation to support adequate vitamin and mineral absorption following bariatric surgery. He was advised to take the medications as prescribed.

The patient was advised to continue the prescribed liquid diet for 10 days, followed by gradual progression to a soft diet as recommended. He was encouraged to walk regularly, maintain adequate hydration, avoid strenuous physical activities and heavy lifting for two months, and adhere to the recommended dietary and lifestyle modifications to support healing and long-term weight loss.

The patient was informed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as fever, severe abdominal pain, persistent vomiting, bleeding, or increasing abdominal distension.

The patient was advised to return for a follow-up visit with a weight loss doctor in Hyderabad at PACE Hospitals after 7 days.

This case highlights the successful management of weight regain following sleeve gastrectomy in a patient with morbid obesity using laparoscopic sleeve conversion to mini gastric bypass (MGB). The procedure was completed without significant complications, and the patient recovered well with stable postoperative progress, supporting improved long-term weight loss and metabolic outcomes.