Advertisement

Laparoscopic modified Nissen fundoplication over Roux-en-Y gastric bypass and hiatal hernia repair for intractable gastroesophageal reflux

      Roux-en-Y gastric bypass (RYGB) is an effective treatment for morbid obesity and gastroesophageal reflux disease (GERD) [
      • Patti M.G.
      An evidence-based approach to the treatment of gastroesophageal reflux disease.
      ] Despite majority of patients with resolution of GERD after RYGB, some patients will continue to complain of significant, persistent reflux symptomatology or develop de novo symptoms despite aggressive medical management. Its true incidence is unknown and 1 study showed an improvement in GERD but not resolution in 22% of patients after RYGB with GERD [
      • Frezza E.E.
      • Ikramuddin S.
      • Gourash W.
      • et al.
      Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass.
      ]. Possible mechanisms may include primary lower esophageal sphincter incompetence, disruption of the angle of His, or development of hiatal hernia with intrathoracic migration of the gastric pouch. Those with refractory reflux or de novo Barrett’s esophagitis have limited options. After ruling out bile reflux, augmentation of the lower esophageal sphincter may be the best option. Examples include the Hill procedure, magnetic sphincter augmentation, or using the ligamentum teres or remnant stomach as a fundoplication wrap [
      • Pescarus R.
      • Sharata A.M.
      • Dunst C.M.
      • Shlomovitz E.
      • Swanström L.L.
      • Reavis K.M.
      Hill procedure for recurrent GERD post-Roux-en-Y gastric bypass.
      ,
      • Munoz-Largacha J.A.
      • Hess D.T.
      • Litle V.R.
      • Fernando H.C.
      Lower esophageal magnetic sphincter augmentation for persistent reflux after Roux-en-Y gastric bypass.
      ,
      • Hawasli A.
      • Phillips A.
      • Tarboush M.
      Laparoscopic management of reflux after Roux-en-Y gastric bypass using the LINX system and repair of hiatal hernia: a case report.
      ,
      • Kawahara N.T.
      • Alster C.
      • Maluf-Filho F.
      • Polara W.
      • Campos G.M.
      • Poli-de-Figueiredo L.F.
      Modified Nissen fundoplication: laparoscopic antireflux surgery after Roux-en-Y gastric bypass for obesity.
      ]. Kawahara et al. [
      • Kawahara N.T.
      • Alster C.
      • Maluf-Filho F.
      • Polara W.
      • Campos G.M.
      • Poli-de-Figueiredo L.F.
      Modified Nissen fundoplication: laparoscopic antireflux surgery after Roux-en-Y gastric bypass for obesity.
      ] first published this technique in a case report in 2012 the technique of using the remnant stomach as a modified Nissen or a 360° fundoplication over the gastric pouch and lower esophageal sphincter. At our institution, we have performed this technique as a revision for refractory reflux after RYGB with success over several years. This is the first video report to demonstrate this technique.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Surgery for Obesity and Related Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Patti M.G.
        An evidence-based approach to the treatment of gastroesophageal reflux disease.
        JAMA Surg. 2016; 151: 73-78
        • Frezza E.E.
        • Ikramuddin S.
        • Gourash W.
        • et al.
        Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass.
        Surg Endosc. 2002; 16: 1027-1031
        • Pescarus R.
        • Sharata A.M.
        • Dunst C.M.
        • Shlomovitz E.
        • Swanström L.L.
        • Reavis K.M.
        Hill procedure for recurrent GERD post-Roux-en-Y gastric bypass.
        Surg Endosc. 2016; 30: 2141-2142
        • Munoz-Largacha J.A.
        • Hess D.T.
        • Litle V.R.
        • Fernando H.C.
        Lower esophageal magnetic sphincter augmentation for persistent reflux after Roux-en-Y gastric bypass.
        Obes Surg. 2016; 26: 464-466
        • Hawasli A.
        • Phillips A.
        • Tarboush M.
        Laparoscopic management of reflux after Roux-en-Y gastric bypass using the LINX system and repair of hiatal hernia: a case report.
        Surg Obes Relat Dis. 2016; 12: e51-e54
        • Kawahara N.T.
        • Alster C.
        • Maluf-Filho F.
        • Polara W.
        • Campos G.M.
        • Poli-de-Figueiredo L.F.
        Modified Nissen fundoplication: laparoscopic antireflux surgery after Roux-en-Y gastric bypass for obesity.
        Clinics (Sao Paulo). 2012; 67: 531-533