Modified Nissen fundoplication: laparoscopic anti-reflux surgery after Roux-en-Y gastric bypass for obesity

Kawahara, Nilton; Alster, C; Maluf‐Filho, Fauze; Polara, Wilson Modesto; Campos, Guilherme M.; Poli-de-Figueiredo, Luiz Francisco

doi:10.6061/clinics/2012(05)23

Cited by 35 publications

(9 citation statements)

References 10 publications

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“…Frezza et al[ 26 ] reported significant decrease in GERD-related symptoms over the 3-year study after LRYGB. Mechanisms of the anti-reflux effect of RYGB include promoting weight loss, lowering acid production in the gastric pouch, diverting bile from the Roux limb, rapid pouch emptying, and decreasing abdominal pressure over the LES[ 27 ]. The impact of LSG on GERD is still an unresolved issue.…”

Section: Discussionmentioning

confidence: 99%

Comparative study of outcomes following laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in morbidly obese patients: A case control study

Garg¹,

Priyadarshini²,

Aggarwal³

et al. 2017

WJGE

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AIMTo compare the impact of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) on weight loss and obesity related comorbidities over two year follow-up via case control study design.METHODSForty patients undergoing LRYGB, who completed their two year follow-up were matched with 40 patients undergoing LSG for age, gender, body mass index and presence of type 2 diabetes mellitus (T2DM). Data of these patients was retrospectively reviewed to compare the outcome in terms of weight loss and improvement in comorbidities, i.e., T2DM, hypertension (HTN), obstructive sleep apnea syndrome (OSAS), hypothyroidism and gastroesophageal reflux disease (GERD).RESULTSPercentage excess weight loss (EWL%) was similar in LRYGB and LSG groups at one year follow-up (70.5% vs 66.5%, P = 0.36) while it was significantly greater for LRYGB group after two years as compared to LSG group (76.5% vs 67.9%, P = 0.04). The complication rate after LRYGB and LSG was similar (10% vs 7.5%, P = 0.99). The median duration of T2DM and mean number of oral hypoglycemic agents were higher in LRYGB group than LSG group (7 years vs 5 years and 2.2 vs 1.8 respectively, P < 0.05). Both LRYGB and LSG had significant but similar improvement in T2DM, HTN, OSAS and hypothyroidism. However, GERD resolved in all patients undergoing LRYGB while it resolved in only 50% cases with LSG. Eight point three percent patients developed new-onset GERD after LSG.CONCLUSIONLRYGB has better outcomes in terms of weight loss two years after surgery as compared to LSG. The impact of LRYGB and LSG on T2DM, HTN, OSAS and hypothyroidism is similar. However, LRYGB has significant resolution of GERD as compared to LSG.

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Section: Discussionmentioning

confidence: 99%

Comparative study of outcomes following laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in morbidly obese patients: A case control study

Garg¹,

Priyadarshini²,

Aggarwal³

et al. 2017

WJGE

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“…In hindsight, the presence of gastro-oesophageal reflux disease after a LHM in a prior gastric bypass could be managed with a fundoplication, using the fundus of the excluded stomach, as described by some authors. 5 However, based on our experience with other LHM cases performed without fundoplication, proton pump inhibitor therapy is very effective for reflux symptoms.…”

Section: Discussionmentioning

confidence: 95%

Heller oesophagomyotomy as treatment for achalasia after gastric bypass for morbid obesity

Nguyen

Dip

Menzo

et al. 2016

annals

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“…The modified Nissen fundoplication is only applicable as a laparoscopic ant reflux surgery after primary RYGB. The procedure consists of a laparoscopic 360 degrees fundoplication to reinforce the LES by wrapping the excluded stomach around the lowest portion of the esophagus (36). Comparatively, the only other surgery described for persistent reflux similar to this modified Nissen technique, was a conventional 270 degrees Belsey Mark IV ant reflux surgery following open RYGB (37).…”

Section: Surgicalmentioning

confidence: 99%

De novo gastroesophageal reflux disease esophageal surgery in bariatrics: a literature review and analysis of the current treatment options

Alemán¹,

Menzo²,

Szomstein³

et al. 2021

Ann Transl Med

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With the exponential increase of worldwide obesity, the number of bariatric surgery (BaS) procedures have equally risen. The surgical management of obesity has been widely established as the standard of care for sustained weight reduction, resolution, and improvement of associated comorbidities. However, BaS itself can have postoperative deleterious effects, including de novo gastroesophageal reflux disease (GERD) and upper gastrointestinal motility disorders. The modified anatomy resulting from BaS, due to either a restrictive or hypoabsorptive component, gives this disorder a multifactorial etiology.The overall management of de novo GERD should focus on three primordial approaches: Non-surgical, endoluminal, and surgical. Even in the absence of de novo GERD following primary or secondary BaS, said disorder should be closely monitored and therapy should be catered in a case-by-case approach.Consequently, treatment strategies have been developed on this principle as to adequately resolve de novo GERD. Despite the presence of multiple and suitable treatment modalities, the operating surgeon should perform them in the best interest of the patient. Short-, medium-, and long-term outcomes should be taken into consideration prior to proceed with any type of preferred management option. This article herein presents an update on the surgical management of de novo GERD following BaS and current practical innovations.

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Modified Nissen fundoplication: laparoscopic anti-reflux surgery after Roux-en-Y gastric bypass for obesity

Cited by 35 publications

References 10 publications

Comparative study of outcomes following laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in morbidly obese patients: A case control study

Comparative study of outcomes following laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in morbidly obese patients: A case control study

Heller oesophagomyotomy as treatment for achalasia after gastric bypass for morbid obesity

De novo gastroesophageal reflux disease esophageal surgery in bariatrics: a literature review and analysis of the current treatment options

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