Roux-En-Y gastric bypass following failed fundoplication

Abstract

Fundoplication takedown with RYGB was successful for long-term reflux resolution. Most can be performed via a minimally invasive approach with acceptable perioperative morbidity, symptom resolution, and the additional benefit of %EWL.

Failure After Fundoplication: Re-Fundoplication? Is There a Room for Gastrectomy? In Which Clinical Scenaries?

“…Despite the initial controversy or rejection of this idea by the majority of surgeons dedicated to this subject, in recent years it has been accepted due to the benefits of a long term follow-up. Others authors have confirmed a decrease in reflux symptoms, proton pump medication, acid reflux and complete regression of Barrett´s esophagus after LRYGBP and for them, LRYGBP is the preferred surgery in morbidly obese patients with BE 12 , 19 , 30 , 32 , 37 . This concept confirmed our idea suggesting this technique as an excellent strategy for these patients 19 .…”

“…Recent papers concluded that laparoscopic conversion of Nissen fundoplication to Roux-en-Y gastric bypass is a technically feasible and safe operation for recurrent gastroesophageal reflux disease in the morbidly obese with prior anti-reflux surgery, and in obese patients requiring surgical treatment for gastroesophageal reflux disease 1 , 12 , 19 , 30 , 31 . In our opinion, laparoscopic Roux-en-Y gastric bypass is the best option for morbidly obese patients with Barrett´s esophagus.…”

“…First of all, the decision to indicate reoperation after failed fundoplication is not easy. The decision to choose a remedial antireflux procedure is a challenging clinical problem which must be individualized depending on the clinical features of the patients, the characteristics and severity of symptoms, type of esophagitis, presence of ulcer, stricture, Barrett´s esophagus, delayed gastric emptying, acid/bile reflux, the number of previous operations and the presence of obesity 10 , 12 , 24 , 27 , 35 , 38 , 44 . All of these factors must be taken into account in order to decide which surgery is the best option after a failed fundoplication.…”

“…Therefore, it is possible to postulate that the combination of both procedures could be the best choice in order to avoid acid and bile reflux. The disadvantage of this alternative is the high rate of in-hospital or postoperative morbidity which can reach up to 67% after gastrectomy compared to only 20% after refundoplication (p=0.007) 10 , 12 , 31 , 33 , 37 , 45 , 47 , 49 , 51 . On the other hand, the advantage of distal gastrectomy is relief of reflux symptoms after surgery, which reach nearly 89% compared to 50% after refundoplication (p=0.044).…”

Efficacy and Safety of Recurrent Paraesophageal Hernia Repair with Roux-en-Y Gastric Bypass

“…To date, many studies have suggested that despite revisional RYGB having a somewhat higher complication rate than revisional fundoplication, it is generally safe and at least as effective as revisional fundoplication in controlling the symptoms of GERD in the short term. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] However, there have been fewer studies assessing the long-term outcomes of patients who undergo RYGB after fundoplication, particularly with regard to the change in the proton pump inhibitor (PPI) use and resolution of obesity-related comorbidities. In this descriptive study, we assess the long-term safety and efficacy of RYGB after failed fundoplication in terms of the complication rate, change in PPI usage, weight loss, and resolution of obesity-related comorbidities.…”