Lengthening of the common channel improves hypoalbuminemia and intractable diarrhea after OAGB/MGB.

Abstract

Abstract Introduction Bariatric surgery is the only sustainable therapy for morbid obesity and its comorbidities. The outcome of any operation is determined by many factors including the limb length in cases involving bypass of various bowel limb lengths. The OAGB combines restrictive as well as malabsorptive properties for weight loss. It is an effective therapy for morbid obesity, but may reduce protein absorption and induce protein deficiency. Objectives & methods: A video of a laparoscopic revision of an OAGB/MGB in a patient with hypoalbuminemia and intractable diarrhea was done edited and is presented. Results The patient was found at surgery to have a 180cm BP limb, and only 200cm common limb. The albumen level dropped from pre-operative 3.25 g/dl to 2.23 g/dl post first OAGB. The gastro enterostomy was taken down and a new anastomosis was made at a point 50cm from the ligaments of Treitz. This left the patient with a BP limb of 50cm and a common limb of 330cm. The Patient had an unremarkable recovery. Her albumen raised to 2.89 g/dl in two months post revision surgery. Conclusion Most patients require at least 300cm of a common limb after OAGB/MGB to minimize the incidence of hypoalbuminemia and intractable diarrhoea. These types of cases can easily be managed by altering the limb lengths of the patient by increasing the common channel to a minimum of 300cms at the expense of the biliopancreatic limb.