Revisional Surgery After One-Anastomosis Gastric Bypass in a Patient with Limb-Girdle Muscular Dystrophy: Case Report

Abstract

Limb-girdle muscular dystrophy (LGMD) refers to a group of genetically heterogeneous, hereditary muscular dystrophies, clinically characterized with progressive symmetric weakness and wasting of shoulder and hip girdle musculature, with the vast majority of the affected patients developing walking disability and eventually becoming wheelchair bound [1]. Global prevalence of severe obesity has exponentially increased over the past several decades [2], and since sedentary lifestyle has been widely cited as a major contributor to obesity and its related chronic diseases, patients with muscular dystrophy are not on the sidelines of this epidemic. Observations have noted 44% of LGMD patients being even disabled to meet minimum thresholds of recommended daily physical activity [3]. One-anastomosis gastric bypass (OAGB) has gained worldwide recognition as a mainstream bariatric procedure over the past two decades [4], with excellent results in terms of weight loss and resolution of concomitant metabolic disorders, equivalent or even superior to the other malabsorptive bariatric procedure, Roux-en-Y gastric bypass (RYGB) [5, 6]. A major point of concern surrounding OAGB, however, is the risk of postoperative nutritional complications [7]; and the length of bypassed small bowel, the biliopancreatic limb (BPL), that is responsible for decreased absorption capacity and postoperative nutritional deficiencies, is the main topic of debate among surgeons performing this procedure. While the original BPL length of 200 cm has been associated with several reports of protein-calorie malnutrition, profound liver failure, and mortality, recent studies, by us and others, have demonstrated that implementing more conservative BPL lengths could successfully prevent protein-calorie malnutrition and the need for revisional surgery after OAGB [7–9]. Hereby we report our first experience with revisional surgery due to severe protein-calorie malnutrition after laparoscopic OAGB using a BPL length of 160 cm in a patient with LGMD.