Endocrine Abstracts

We describe the case of a 32-year-old lady Polish lady, who presented to the surgical team at Leeds Teaching Hospitals NHS Trust in July 2012 with abdominal pain and vomiting. The previous year she had undergone a private ‘banded bypass’ operation in Poland resulting in 60 kg weight loss. On admission she was diagnosed with a slipped gastric band, to be confirmed by laparoscopy. Surprisingly the ‘band’ was in fact a length of surgical drain sutured to the middle third of the stomach and the patient had in fact received a jejunoileal bypass (JIB) with a blind ending jejunal loop, rather than a Fobi pouch gastric bypass as she had been led to believe. The lower portion of the stomach along with part of the omentum had slipped through this homemade ‘band’, removal of which alleviated her symptoms. Following discharge it was decided to convert the JIB to a conventional Roux-en-Y gastric bypass (RYGB) due to malabsorptive symptoms, once funding was approved. In the interim she was admitted acutely a second time due to an episode of intussusception within the blind end of jejunum and so the JIB was converted to a RYGB to prevent further occurrences. The complications encountered in this case illustrate why JIB operations have largely been outlawed within the bariatric community as a weight loss procedure. Patients undergoing bariatric procedures abroad frequently encounter difficulties due to a lack of long term nutritional follow up along with poor peri-operative support. Although the case presented is a rarity, these patients may require revision surgery for a variety of reasons, placing extra strain on the NHS and can be further complicated by funding difficulties. Whether the current guidelines for funding of bariatric surgery would have prevented the second admission is unclear.