43 yo lady, in 2005 weighted 330Lbs. Had a Bariatric Surgery - Vertical banded gastroplasty, pancreato-biliary diversion procedure (125 cm of ileum distal to the roux-en-y site, 125 cm between gastrojejunostomy and roux-en-y site, 250 cm from ligament of trietz to roux-en-y site -- per the op notes), and gallbladder removed.
Weighed 150 lbs within 1 year. Reportedly needed several courses of TPN in 2011&12.
Had frequent, loose stools until about 2 years ago. Now stools much less frequent (??cathartic colon??)
Currently looks like she is 70, weighs 130 Lbs, has anasarca, albumin 2.7, LFT's normal except alk phos 350, mildly anemic and macrocytic (B12 borderline low, is already on folate supplementation), thyroid tests normal, electrolytes ok, calcium 8.0 (uncorrected for albumin), and is heme positive. EGD and colonoscopy show the expected post-op anatomy, but otherwise are normal.
She obviously needs nutritional support and then reversal of her diversion procedure. My questions are:
Would you simply move the roux-en-y site as close to the gastrojejunostomy site as possible, or would you try to give her even more absorptive surface by moving some of the diverted limb back incontinuity with the flow of chyme?? Is it even technically possible to do so and preserve blood supply?
Does anybody know of a good review on reversal of pancreato-biliary diversion procedures?