LETTER TO THE EDITOR Reply to the Letter BGastric Remnant Dilatation: a Rare Technical Complication Following Laparoscopic One Anastomosis (Mini) Gastric Bypass^ Wei-Jei Lee 1 & Abdullah Almulaifi 2 Published online: 14 August 2017 # Springer Science+Business Media, LLC 2017 Dear Sir, We read with great interest the article titled, BGastric rem- nant dilatation: A rare technical complication following Laparoscopic One Anastomosis (Mini) Gastric Bypass.^ [1] We would like to add our experience in the hope that this will complement the information, considering that we reported the first case in the world [2]. Acute gastric dilatation is a surgical emergency after Roux-en-Y gastric bypass (RYGB), usually known as biliopancreatic obstruction caused by obstruction at enteroenterostomy [3]. Although the incidence is low, this complication is an important cause of death after RYGB [4]. The laparoscopic mini gastric bypass (MGB) first reported by Rutledge was gradually accepted as an alternative to RYGB with better weight loss and less complication, especially in less intestinal obstruction [5]. New names such as one anas- tomotic gastric bypass (OAGB) or single anastomosis gastric bypass (SAGB) were proposed [6]. Although SAGB or MGB is a simplified bypass procedure with less complication than RYGB, acute gastric dilatation is still a possible early compli- cation [7]. Acute gastric dilatation after MGB is less severe than that after RYGB because it does not carry a risk of de- veloping a fulminant pancreatitis, although it may cause gas- tric wall perforation or necrosis if diagnosis is delayed. The diagnosis can be suspected on a plain abdominal radiograph that shows a distended fundus and then confirmed by using computed tomography (CT). About this rare complication, the most important point is to avoid complications, especially in the learning curve of this procedure. The author described elaborately in their letter the cause and prevention of developing acute gastric dilatation of MGB. I agree with the author that attention should be paid at the first cut when trying to create a long narrow gastric tube and leave a space of 2 cm from the greater curvature side. Instead of using a 60-mm stapler for the first cut, we preferred to use a 45-mm stapler for the first cut, which may reduce the risk of overcutting at the antrum. In the letter, the authors discussed the management of this complication and proposed to use diagnostic laparoscopy and correction surgery in emergency situations. The authors ar- gued that tube gastrostomy adding 2% to operative risk was misleading. Today, percutaneous drainage of gastric remnant dilatation by CT scan or with echo guidance can be easily performed under local anesthesia [8–10]. The drainage is ef- fective for symptom relief and to avoid emergency operation, which might put the patient in an unnecessary risk. An elective surgery can be arranged later. Corrective operation may be needed if the narrowing at the antrum persists. Either a side- to-side anastomosis, as the author suggested, or resection of the remnant stomach can resolve the problem. Thus far, we have experienced three cases (0.15%) of acute gastric dilata- tion among 2000 cases of SAGB. The incidence is lower than the incidence of 0.8% after RYGB [7]. Two of the three cases were successfully managed with percutaneous drainage. One patient received an elective surgery to remove the remnant stomach 1 month later because of persistent symptomatic narrowing. One patient presented with gastric bleeding and acute gastric dilatation filled with blood clot. Emergency lap- aroscopic surgery was performed to evacuate the blood clot, and continuous suture of the stapler line for hemostasis was applied. All the patients were discharged within 3 days un- eventfully. In conclusion, this rare complication should be * Wei-Jei Lee wjlee_obesssurg_tw@yahoo.com.tw 1 Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Tauoyan, Taiwan, Republic of China 2 Department of Surgery, Jaber Al Ahmad Armed Forces Hospital, Kuwait City, Kuwait OBES SURG (2017) 27:2682–2683 DOI 10.1007/s11695-017-2821-4