Minimally invasive Management of RYGB Complicat ions: The Role of Combined Laparoscopic and Endoscopic Techniques

Minimally invasive Management of RYGB Complicat ions: The Role of Combined Laparoscopic and Endoscopic Techniques

Roux-en-Y gastric bypass (RYGB) is a cornerstone of bariatric surgery, yet late complications like candy cane syndrome and anastomotic strictures can severely impair patient outcomes. We report a complex case of a 30-yearold woman (initial BMI 40.33) who presented with persistent dysphagia and critical weight loss (BMI 22.40) due to a refractory gastrojejunostomy stricture following prior surgical resection for candy cane syndrome. Despite multiple failed endoscopic balloon dilations and lumen-apposing metal stent placement, the patient remained symptomatic. Definitive management was achieved via a hybrid laparoscopic-endoscopic approach, featuring extensive adhesiolysis, complete resection of the dilated gastric pouch, and reconstruction with a latero-lateral esophagojejunostomy. Intraoperative endoscopy was pivotal in guiding dissection and verifying luminal patency. The patient recovered uneventfully with complete resolution of symptoms. This case underscores that a multidisciplinary, hybrid minimally invasive strategy offers a safe and effective salvage option for complex, refractory post-RYGB complications.