Introduction: Anatomical gastrointestinal reconstruction following metabolic bariatric surgery (MBS) is a revisional procedure used for refractory complications, including malnutrition, intractable reflux, recurrent marginal ulcer disease, and post-bariatric hyperinsulinemic hypoglycemia (PBHH). Objective: This study aims to describe the indications, perioperative outcomes, and short-term results of laparoscopic anatomical reconstruction in a single-center series, focusing on patients with PBHH. Methods: We retrospectively reviewed 11 consecutive patients who underwent reconstruction following MBS at a single tertiary center. Perioperative outcomes, weight changes, and biochemical responses to standardized dual-modality (oral and intravenous) glucose suppression testing were analyzed. Results: Between 2018 and 2025, 11 patients completed laparoscopic anatomical reconstruction. The anatomy immediately preceding reconstruction was OAGB in nine patients (81.8%) and RYGB in two (18.2%). The indications overlapped; the most common were severe malnutrition (n = 9), marginal ulcer disease (n = 6), and PBHH (n = 4; three biochemically confirmed, one clinically diagnosed). Ten of eleven procedures (90.9%) were completed laparoscopically, with no 30-day Clavien–Dindo grade III–IV complications. Among the four PBHH patients, symptomatic resolution was achieved in all four, with residual asymptomatic biochemical hypoglycemia in one. Weight gain occurred in 10 of the 11 patients (mean 8.1 ± 4.9 kg) at a median follow-up of 7 months (IQR 3–12). Conclusions: In this preliminary series, laparoscopic anatomical reconstruction was feasible, though the small sample precludes conclusions regarding safety. Incretin hormones were not measured; the mechanistic contribution of restored foregut anatomy is inferred from prior literature rather than demonstrated here. Standardized dual-modality glucose suppression testing was central to patient selection and to documenting the biochemical response.

A 61‐year‐old woman presented with abdominal pain, vomiting, and distension 13 years after laparoscopic adjustable gastric banding (LAGB). Imaging showed small bowel obstruction (SBO) caused by distal migration of the gastric band into the jejunum. As she was hemodynamically stable without peritonitis, a conservative management strategy was adopted. Bedside removal of the subcutaneous port was performed to release tubing tension, followed by nasogastric decompression and supportive therapy. Serial imaging confirmed gradual distal movement of the band, which was spontaneously expelled per rectum on the fifth hospital day. The patient recovered fully without surgical intervention. This case highlights the importance of individualized management and demonstrates that conservative therapy, including port removal, can be a safe and effective alternative to surgery for stable patients with distal gastric band migration–related obstruction.

Introduction and importance: Postprandial hyperinsulinemic hypoglycemia (PHH) is a significant, rare complication following Roux-en-Y gastric bypass (RYGB). Management is challenging in patients with complex revisional surgical histories, where conservative treatments often fail. This case highlights the need for individualized surgical solutions for severe, refractory PHH in this unique patient population. Case presentation: We present a 71-year-old woman with a history of a sleeve gastrectomy revised to an RYGB, who developed debilitating hypoglycemic episodes refractory to conservative management. An oral glucose tolerance test (OGTT) yielded results consistent with PHH, revealing a paradoxical glucose drop with an exaggerated insulin and C-peptide response. Clinical discussion: Given her complex anatomy and atypical, low-volume gastric remnant consisting primarily of the antrum, a laparoscopic Branco–Zorron switch was performed to restore pyloric function and delay gastric emptying. Postoperatively, the patient experienced sustained resolution of her hypoglycemic symptoms, accompanied by positive weight gain and high satisfaction. Her recovery was complicated by an intra-abdominal abscess, which was successfully managed conservatively. Conclusion: The Branco–Zorron switch is a promising surgical option for severe, refractory PHH, particularly in patients with complex post-bariatric anatomies. This case underscores the efficacy of tailored reconstructive approaches when standard treatments fail and emphasizes the need for vigilant postoperative care. Despite the limitations of a single case report, this outcome supports considering the procedure for carefully selected patients.

Background: Postoperative ventral hernia (POVH) remains a significant complication following laparoscopic colectomy despite minimally invasive approaches. Extraction site selection may influence POVH incidence, yet optimal location remains controversial. Methods: This retrospective cohort study analyzed 550 patients undergoing elective laparoscopic right colectomy (2009–2024) at a single center. After exclusions for anastomotic leak and loss to follow-up, 266 patients were propensity-matched 1:1 comparing paramedian (n = 133) versus midline (n = 133) extraction sites. The primary outcome was POVH incidence at 36 months. Secondary outcomes included risk factor identification using multivariate logistic regression and Firth penalized methods. Results: POVH occurred in 3/133 (2.3%) paramedian versus 15/133 (11.3%) midline patients (p = 0.007). Multivariate analysis identified midline extraction (aOR 30.3, 95% CI: 3.34–969, p < 0.001), chronic cough (aOR 25.6, 95% CI: 3.56–287, p = 0.001), and constipation (aOR 10.1, 95% CI: 1.60–70.7, p = 0.015) as independent POVH predictors. Patient comorbidities showed stronger associations than surgical factors in univariate analysis. The number needed to treat with paramedian extraction to prevent one POVH was 11.1. Conclusions: Paramedian extraction sites significantly reduce POVH incidence compared to midline approaches in laparoscopic right colectomy. The identification of modifiable physiological risk factors, particularly conditions causing increased intra-abdominal pressure (chronic cough, constipation), suggests that comprehensive perioperative optimization targeting these specific factors may further reduce POVH risk.