Roux-en-O after revisional bariatric surgery: a rare complication following OAGB to RYGB conversion

Roux-en-O (ROGB) configuration is a rare technical complication caused by incorrect limb orientation, resulting in biliopancreatic secretions draining into the gastric pouch. We report a 47-year-old female with multiple prior bariatric surgeries who underwent conversion to Roux-en-Y gastric bypass for refractory gastroesophageal reflux disease and developed persistent food intolerance, bilious vomiting, and reflux. ROGB was suspected on imaging and confirmed intraoperatively. Surgical revision with reconstruction of the gastrojejunostomy and jejunojejunostomy restored proper limb orientation, leading to complete symptom resolution. This case emphasizes the importance of careful limb identification during revisional bariatric surgery to prevent this rare complication.