Roux-En-Y gastric bypass following failed fundoplication.

Area of Science:

• Gastroenterology
• Bariatric Surgery
• Surgical Outcomes

Background:

• Failed antireflux surgery, such as fundoplication, often leads to persistent symptoms like reflux and dysphagia.
• Reoperative surgery is necessary for patients with refractory symptoms after initial anti-reflux procedures.
• Roux-En-Y gastric bypass (RYGB) presents a potential alternative for managing complex cases of failed fundoplication.

Purpose of the Study:

• To evaluate the long-term efficacy of Roux-En-Y gastric bypass (RYGB) in patients with a history of failed fundoplication.
• To assess the resolution of gastroesophageal reflux disease (GERD) symptoms and other related complaints post-RYGB.
• To analyze the perioperative outcomes and excess body weight loss (%EWL) following RYGB in this specific patient cohort.

Main Methods:

• A prospective study involving 87 patients who underwent fundoplication takedown and RYGB between March 2007 and September 2016.
• Data collection included demographics, BMI, preoperative symptoms, operative details, and postoperative outcomes.
• Statistical analysis was performed to assess symptom resolution, complications, and %EWL.

Main Results:

• RYGB successfully treated recurrent reflux in 87.4% of patients (11.4% experienced recurrent symptoms).
• Common findings during RYGB included hiatal hernia (85.1%) and fundoplication migration or disruption (up to 34.5%).
• The procedure resulted in significant excess body weight loss (%EWL) of 80.4% with no mortality, though 8 patients required reoperation.

Conclusions:

• Fundoplication takedown followed by RYGB is a successful strategy for achieving long-term resolution of reflux symptoms.
• Minimally invasive RYGB approaches are feasible, associated with acceptable morbidity, and provide the added benefit of significant weight loss.