{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:23:54Z","timestamp":1787318634859,"version":"build-2736575974"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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\u00a0years 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\u2019s 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.<\/jats:p>","DOI":"10.1093\/jscr\/rjag593","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T11:30:04Z","timestamp":1784633404000},"source":"Crossref","is-referenced-by-count":0,"title":["Multifactorial late complications 13\u00a0years after conversion to Roux-en-Y gastric bypass: a case report"],"prefix":"10.1093","volume":"2026","author":[{"given":"Maximo Vicente","family":"Torres Guaicha","sequence":"first","affiliation":[{"name":"Department of Surgery, Hospital Metropolitano de Quito , Avenida Mariana de Jes\u00fas S\/N y Nicol\u00e1s Arteta, 170521, Quito ,","place":["Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tabata L","family":"Tinoco Ortiz","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Metropolitano de Quito , Avenida Mariana de Jes\u00fas S\/N y Nicol\u00e1s Arteta, 170521, Quito ,","place":["Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenda Y","family":"Herrera Cevallos","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Metropolitano de Quito , Avenida Mariana de Jes\u00fas S\/N y Nicol\u00e1s Arteta, 170521, Quito ,","place":["Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amilcar","family":"Herrera Cevallos","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Metropolitano de Quito , Avenida Mariana de Jes\u00fas S\/N y Nicol\u00e1s Arteta, 170521, Quito ,","place":["Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul M","family":"Tovar-Cobos","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidad San Francisco de Quito , Avenida Diego de Robles S\/N y V\u00eda Interoce\u00e1nica, 170901, Quito ,","place":["Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"2026082108273953400_ref1","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1016\/S0140-6736(25)00355-1","article-title":"Global, regional, and national prevalence of adult overweight and obesity, 1990\u20132021, with forecasts to 2050: a forecasting study for the global burden of disease study 2021","volume":"405","author":"Ng","year":"2025","journal-title":"The Lancet"},{"key":"2026082108273953400_ref2","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1001\/jama.2020.12567","article-title":"Benefits and risks of bariatric surgery in adults: a review","volume":"324","author":"Arterburn","year":"2020","journal-title":"JAMA"},{"key":"2026082108273953400_ref3","doi-asserted-by":"publisher","first-page":"3246","DOI":"10.1007\/s11695-025-08044-8","article-title":"Long-term outcomes in sleeve gastrectomy versus Roux-en-Y gastric bypass: a systematic review and meta-analysis of randomized trials","volume":"35","author":"Monteiro Delgado","year":"2025","journal-title":"Obes Surg"},{"key":"2026082108273953400_ref4","doi-asserted-by":"publisher","first-page":"100836","DOI":"10.1016\/j.lanepe.2024.100836","article-title":"Long-term effect of sleeve gastrectomy vs Roux-en-Y gastric bypass in people living with severe obesity: a phase III multicentre randomised controlled trial (sleevebypass)","volume":"38","author":"Biter","year":"2024","journal-title":"Lancet Reg Health - Eur"},{"key":"2026082108273953400_ref5","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1097\/SLA.0000000000004297","article-title":"Comparative safety of sleeve gastrectomy and gastric bypass: an instrumental variables approach","volume":"275","author":"Chhabra","year":"2022","journal-title":"Ann Surg"},{"key":"2026082108273953400_ref6","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1097\/SLA.0000000000003279","article-title":"Gastric bypass versus sleeve gastrectomy: patient selection and short-term outcome of 47,101 primary operations from the Swedish, Norwegian, and Dutch National Quality Registries","volume":"272","author":"Poelemeijer","year":"2020","journal-title":"Ann Surg"},{"key":"2026082108273953400_ref7","doi-asserted-by":"publisher","first-page":"1486","DOI":"10.1007\/s11695-023-06546-x","article-title":"Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: indications, prevalence, and safety","volume":"33","author":"Dang","year":"2023","journal-title":"Obes Surg"},{"key":"2026082108273953400_ref8","doi-asserted-by":"publisher","first-page":"7947","DOI":"10.1007\/s00464-023-10261-0","article-title":"Laparoscopic sleeve gastrectomy to Roux-en-Y gastric bypass conversion versus primary Roux-en-Y gastric bypass: a propensity score matching analysis","volume":"37","author":"O\u2019Laughlin","year":"2023","journal-title":"Surg Endosc"},{"key":"2026082108273953400_ref9","doi-asserted-by":"publisher","first-page":"1096","DOI":"10.1001\/jamasurg.2023.3211","article-title":"Abdominal pain after Roux-en-Y gastric bypass: a review","volume":"158","author":"Fry","year":"2023","journal-title":"JAMA Surg"},{"key":"2026082108273953400_ref10","doi-asserted-by":"publisher","first-page":"3266","DOI":"10.1007\/s11695-024-07249-7","article-title":"Long-term (11 years) results of laparoscopic gastric bypass: changes in weight, blood levels of sugar and lipids, and late adverse effects: laparoscopic gastric bypass results","volume":"34","author":"Deycies Gaete","year":"2024","journal-title":"Obes Surg"},{"key":"2026082108273953400_ref11","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1007\/s11695-015-1918-x","article-title":"Antecolic or Retrocolic alimentary limb in laparoscopic Roux-en-Y gastric bypass? A meta-analysis","volume":"26","author":"Rondelli","year":"2016","journal-title":"Obes Surg"},{"key":"2026082108273953400_ref12","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1007\/s11695-018-3594-0","article-title":"Concomitant hiatal hernia repair is more common in laparoscopic sleeve gastrectomy than during laparoscopic Roux-en-Y gastric bypass: an analysis of 130,772 cases","volume":"29","author":"Docimo","year":"2019","journal-title":"Obes Surg"},{"key":"2026082108273953400_ref13","doi-asserted-by":"publisher","DOI":"10.1097\/SLE.0000000000001366","article-title":"Mechanisms of gastroesophageal reflux post-Roux-en-Y gastric bypass: universal alteration of the antireflux barrier is the culprit","volume":"35","author":"Abu","year":"2025","journal-title":"Surg Laparosc Endosc Percutan Tech"},{"key":"2026082108273953400_ref14","doi-asserted-by":"publisher","first-page":"4910","DOI":"10.1007\/s00464-022-09653-5","article-title":"Repairing small type I hiatal hernias at the time of RYGB is not necessary to achieve resolution of reflux symptoms","volume":"37","author":"Khouri","year":"2023","journal-title":"Surg Endosc"},{"key":"2026082108273953400_ref15","doi-asserted-by":"publisher","first-page":"1102","DOI":"10.1016\/j.soard.2025.06.007","article-title":"Outcomes of hiatal hernia repair after Roux-en-Y gastric bypass: largest retrospective cohort study to date","volume":"21","author":"Lyo","year":"2025","journal-title":"Surg Obes Relat Dis"}],"container-title":["Journal of Surgical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2026\/8\/rjag593\/70752841\/rjag593.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2026\/8\/rjag593\/70752841\/rjag593.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:27:41Z","timestamp":1787315261000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jscr\/article\/doi\/10.1093\/jscr\/rjag593\/8767694"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":15,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8,4]]}},"URL":"https:\/\/doi.org\/10.1093\/jscr\/rjag593","relation":{},"ISSN":["2042-8812"],"issn-type":[{"value":"2042-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,8]]},"article-number":"rjag593"}}