In a medical milestone, surgeons have documented the first case of a revisional metabolic procedure performed entirely through Regional Anesthesia Bariatric Surgery. Traditionally, clinicians manage complex procedures like the Roux-en-Y gastric bypass (RYGB) using general anesthesia. However, this novel approach utilizes combined thoracic spinal-epidural anesthesia (CTSEA) to minimize respiratory risks. Consequently, the case highlights a paradigm shift in how anesthesiologists approach high-risk patients with obesity.

The case involved a 41-year-old female patient suffering from weight regain and reflux after a previous sleeve gastrectomy. Her body mass index (BMI) was 37.1 kg/m². Notably, the patient requested regional anesthesia to avoid the potential complications of general anesthesia. The surgical team successfully converted her sleeve gastrectomy to an RYGB under CTSEA and bilateral superficial cervical plexus blocks. These blocks specifically helped prevent shoulder pain during the laparoscopic inflation phase.

Advantages of Regional Anesthesia Bariatric Surgery

The outcomes of this approach were remarkably positive for the patient and the surgical team. For instance, the patient ambulated and resumed oral intake within hours of the procedure. Moreover, the medical team discharged her on postoperative day one. By avoiding systemic opioids, the patient experienced excellent pain control without typical narcotic side effects. Furthermore, the surgeons reported high satisfaction with the operating conditions and patient cooperation. This feasibility suggests that regional techniques are viable alternatives for selected complex cases.

What is Combined Thoracic Spinal-Epidural Anesthesia (CTSEA)?

CTSEA is an advanced regional technique that provides deep surgical anesthesia for the abdomen while keeping the patient conscious. It combines spinal and epidural methods to ensure stable hemodynamic conditions during complex bariatric procedures without requiring a ventilator.

Why is this case considered a milestone?

While primary bariatric surgeries occasionally use regional blocks, this case represents the first successful laparoscopic revisional surgery performed entirely without general anesthesia. This proves the feasibility of regional techniques in technically challenging, long-duration metabolic conversions where general anesthesia risks are higher.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Soltan WA et al. World's first revisional metabolic bariatric surgery under regional anesthesia: Laparoscopic conversion of sleeve gastrectomy to Roux-en-Y gastric bypass, a case report. Obes Facts. 2026 Feb 26. doi: 10.1159/000551102. PMID: 41746873.

Gupta A. Regional anesthesia for bariatric surgery. Bariatric Times. 2013;10(6):10–13.

Nielsen KC, Guller U, Steele SM, et al. Influence of obesity on surgical and anesthetic outcomes. Anesthesiology. 2005;102(3):611-617.