Case report: Acute gastric remnant dilation following laparoscopic mini-gastric bypass in a patient using GLP-1 receptor agonist

Acute gastric remnant dilation is a rare but potentially serious complication following mini-gastric bypass (MGB). While the majority of such cases have been reported after Roux-en-Y gastric bypass (RYGB), this case highlights a unique presentation following MGB. Additionally, the potential role of GLP-1 receptor agonists in influencing gastric motility and contributing to postoperative complications is explored.

A 44-year-old female with morbid obesity (BMI: 40) underwent laparoscopic MGB after unsuccessful weight loss attempts through lifestyle interventions and liraglutide (Saxenda) use. Postoperatively, the patient developed tachycardia and hypertension without gastrointestinal symptoms. Imaging revealed a dilated gastric remnant with a suspected stricture near surgical clips. Diagnostic laparoscopy identified a mildly kinked pylorus but no definitive obstruction. Despite stricture plasty, the patient continued to experience gastric dilation and required remnant gastrectomy. The patient’s prior use of GLP-1 receptor agonists may have contributed to delayed gastric emptying and the development of this complication. The patient recovered well, achieving significant weight loss (BMI: 28) and metabolic improvement.

The case highlights the necessity of precise surgical techniques, mainly stapler placement, to avoid gastric remnant issues after MGB. It also stresses the need to consider the effects of GLP-1 receptor agonists on gastric motility in patients with prior use. Early detection and intervention are vital for preventing serious complications. Additionally, for patients receiving GLP-1 receptor agonists who are planned for bariatric surgery, discontinuation of these agents for an adequate period preoperatively may help prevent delayed gastric emptying and reduce the risk of remnant dilation.