Supplementary Material for: World's first revisional metabolic bariatric surgery under regional anesthesia: Laparoscopic conversion of sleeve gastrectomy to Roux-en-Y gastric bypass, a case report.

Background: Revisional Roux-en-Y gastric bypass (RYGB) after Laparoscopic sleeve gastrectomy (LSG) is effective and traditionally managed with general anesthesia (GA). Regional anesthesia techniques like combined thoracic spinal-epidural anesthesia (CTSEA) may offer advantages in reducing respiratory complications, early mobility and enhancing recovery, but their feasibility in complex revisional bariatric surgery remains unexplored.
Case Presentation: A 41-year-old female with recurrent weight gain (BMI 37.1 kg/m²) and reflux after LSG underwent revisional RYGB under CTSEA supplemented with bilateral superficial cervical plexus blocks (for shoulder pain prophylaxis) at her request and consent. Detailed anesthetic and surgical techniques are described. The 165-minute laparoscopic procedure was successfully completed without conversion to GA. The patient was comfortable intraoperatively and postoperatively.
Outcomes: The patient ambulated and resumed oral intake within hours. She was discharged on postoperative day one. Excellent pain control was achieved without systemic opioids. Surgeons reported high satisfaction with operating conditions and patient cooperation.
Conclusion: This case demonstrates the first documented successful performance of revisional RYGB (conversion from LSG) entirely under regional anesthesia (CTSEA with cervical blocks). It highlights the feasibility of this approach in a conversion procedure, resulting in enhanced recovery (early ambulation/oral intake, opioid avoidance, rapid discharge) and comparable surgical outcomes. This suggests regional anesthesia is a viable alternative to GA for selected patients undergoing complex bariatric surgery, warranting further comparative studies to evaluate its broader applicability, safety, and efficacy.