The Surgical Technique of Primary Modified Fundoplication Using the Excluded Stomach with Simultaneous Gastric Bypass

The aim of this work is to demonstrate a new concept of the surgical technique "FundoRing" for the prevention of acid and bile reflux esophagitis after gastric bypass.

A laparoscopic surgical technique of gastric bypass simultaneous with combined upper total and lower left partial fundoplication. This described case is a participant in an ongoing randomized clinical trial.

The patient was without complications and was discharged on the third postoperative day. Delta BMI was 14 kg/m² (38-24) at the 1-year follow-up. The patient did not have heartburn or bile reflux esophagitis after surgery. Evaluation of the mucosa of the esophagus by upper endoscopy after each of the 3 follow-up visits demonstrated that reflux esophagitis had resolved. Intraoperative fluorescence imaging technologies (NIR/ICG) (IMAGE1 S™ Rubina®) were to determine the quality of blood supply-no violation of the blood supply to the fundoplication wrap of the gastric pouch was detected. A CT scan clearly shows a fundoplication ring around the esophagus (two-thirds) and the upper part of the gastric pouch (one-third).

The surgical technique of primary modified fundoplication using the excluded stomach with simultaneous gastric bypass is feasible.