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Laparoscopic Roux-en-Y gastric bypass after previous Nissen fundoplication

Published:November 17, 2008DOI:https://doi.org/10.1016/j.soard.2008.11.004
      The prevalence of both gastroesophageal reflux disease (GERD) and obesity has increased significantly during the past 25 years, and an association between the 2 has been demonstrated [
      • Fisher B.L.
      • Pennathur A.
      • Mutnick J.L.
      • et al.
      Obesity correlates with gastroesophageal reflux.
      ,
      • Locke G.R.
      • Talley N.J.
      • Fett S.L.
      • et al.
      Risk factors associated with symptoms of gastroesophageal reflux.
      ,
      • Barak N.
      • Ehrenpreis E.D.
      • Harrison J.R.
      • et al.
      Gastro-oesophageal reflux disease in obesity: pathophysiological and therapeutic considerations.
      ,
      • El-Serag H.
      The association between obesity and GERD: a review of the epidemiological evidence.
      ,
      • Friedenberg F.K.
      • Xanthopoulos M.
      • Foster G.D.
      • et al.
      The association between gastroesophageal reflux disease and obesity.
      ,
      • Ikramuddin S.
      Surgical management of gastroesophageal reflux disease in obesity.
      ]. Laparoscopic Nissen fundoplication has been shown to be safe and effective in the treatment of GERD and to offer significant advantages compared with long-term medical therapy [
      • Lundell L.
      • Miettinen P.
      • Myrvold H.E.
      • et al.
      Continued (5-year) followup of a randomized clinical study comparing antireflux surgery and omeprazole in gastroesophageal reflux disease.
      ,
      • Anvari M.
      • Allen C.
      Five-year comprehensive outcomes evaluation in 181 patients after laparoscopic Nissen fundoplication.
      ,
      • Mahon D.
      • Rhodes M.
      • Decadt B.
      • et al.
      Randomized clinical trial of laparoscopic Nissen fundoplication compared with proton-pump inhibitors for treatment of chronic gastro-oesophageal reflux.
      ,
      • Mehta S.
      • Bennett J.
      • Mahon D.
      • et al.
      Prospective trial of laparoscopic Nissen fundoplication versus proton pump inhibitor therapy for gastroesophageal reflux disease: seven-year follow-up.
      ,
      • Kelly J.J.
      • Watson D.I.
      • Chin K.F.
      • et al.
      Laparoscopic Nissen fundoplication: clinical outcomes at 10 years.
      ,
      • Lundell L.
      • Miettinen P.
      • Myrvold H.E.
      • et al.
      Seven-year follow-up of a randomized clinical trial comparing proton-pump inhibition with surgical therapy for reflux oesophagitis.
      ]. However, it might have decreased efficacy in morbidly obese patients [
      • Perez A.R.
      • Moncure A.C.
      • Rattner D.W.
      Obesity adversely affects the outcome of antireflux operations.
      ,
      • Morgenthal C.B.
      • Lin E.
      • Shane M.D.
      • et al.
      Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes.
      ]. Thus, an increasing number of patients might require a bariatric procedure after previous Nissen fundoplication, whether for weight loss or recurrent reflux [
      • Houghton S.G.
      • Nelson L.G.
      • Swain J.M.
      • et al.
      Is Roux-en-Y gastric bypass safe after previous antireflux surgery? Technical feasibility and postoperative symptom assessment.
      ]. We present the case of a morbidly obese patient who had undergone Nissen fundoplication and presented 8 years later desiring bariatric surgery.

      Keywords

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