Multifactorial late complications 13 years after conversion to Roux-en-Y gastric bypass: a case report

Late complications after conversion to Roux-en-Y gastric bypass (RYGB) may present many years after the index procedure and often pose significant diagnostic challenges. We report the case of a 51-year-old woman with persistent postprandial upper abdominal pain and worsening gastroesophageal reflux disease 13 years after conversion from sleeve gastrectomy to RYGB. She had previously undergone cholecystectomy without symptom resolution. Imaging suggested incisional hernia, hiatal hernia and internal hernia. Diagnostic laparoscopy revealed a Petersen's space internal hernia without ischemia, anomalous crossing of the alimentary and biliopancreatic limbs, a sliding hiatal hernia, dense adhesions, and a small incisional hernia. Comprehensive surgical correction was performed, resulting in complete symptom resolution. This case highlights the multifactorial nature of late complications after revisional bariatric surgery and underscores the importance of maintaining a high index of suspicion for complex anatomical causes of persistent abdominal pain.