Laparoscopic Reversal of Roux-en-Y Gastric Bypass for Isolated Refractory Postoperative Nausea: A Case Report

Reversal of Roux-en-Y gastric bypass (RYGB) is an uncommon but sometimes necessary intervention for patients who develop severe, therapy-resistant postoperative symptoms, for example, dumping syndrome, excessive weight loss, and refractory nausea. We report the case of a 39-year-old female who developed persistent nausea, anorexia, weakness, and profound weight loss following uncomplicated RYGB. Despite nutritional counselling, antiemetic therapy, and subsequent laparoscopic repair of Petersen's defect, her symptoms recurred without identifiable radiologic or biochemical abnormalities. Given the persistence and intensity of her symptoms, a laparoscopic reversal to normal anatomy was performed 15 months after the initial operation. Postoperatively, she experienced complete resolution of nausea and anorexia, with weight stabilisation and remission of prior musculoskeletal pain and gastroesophageal reflux disease, which was confirmed at the four-month follow-up. This case highlights the diagnostic and therapeutic challenges associated with refractory postoperative nausea after RYGB, the need for careful multidisciplinary evaluation, including consideration of psychological contributors, and the role of reversal surgery as a last resort when conservative management fails. Bariatric surgery effectively treats obesity, but rare complications such as refractory nausea can increase morbidity, as illustrated by the present case. According to the current literature, management should prioritise conservative therapy, with surgical intervention reserved for unresponsive cases. This report has several limitations, including limited conservative management before reversal, an absence of an in-depth psychiatric evaluation, and a short postoperative follow-up period. To the best of the authors' knowledge, this is the only reported case describing isolated, persistent nausea following RYGB in the absence of identifiable structural or biochemical abnormalities.