Gastric remnant fundoplication for refractory GERD post-roux-en-Y gastric bypass: A case report

Gastroesophageal reflux disease (GERD) commonly affects individuals with obesity, often worsened by increased intra-abdominal pressure and hiatal hernias. Roux-en-Y gastric bypass (RYGB) is preferred for obese patients with GERD due to its effectiveness in weight loss and symptom relief, but some patients experience persistent or recurrent GERD post-surgery. In cases resistant to medical treatment, additional surgical intervention may be required. This case report described using the gastric remnant for fundoplication in patients with refractory GERD after RYGB.

A 48-year-old female with obesity and GERD underwent RYGB with concurrent hiatal hernia repair. Despite initial improvement, she developed treatment-resistant GERD. Endoscopy revealed esophagitis and bile reflux. Due to the severity of her symptoms, a revisional surgery was performed using the gastric remnant for fundoplication, leading to complete symptom resolution postoperatively.

Managing GERD post-RYGB is challenging when medical therapy fails. Traditional fundoplication is unfeasible due to the absence of a gastric fundus. Alternative approaches, such as Hill's repair, ligamentum teres cardiopexy, and magnetic sphincter augmentation, have uncertain long-term efficacy. Gastric remnant fundoplication offers a promising solution by restoring the anti-reflux mechanism while preserving bypass anatomy.

Refractory GERD after RYGB is a significant challenge. Gastric remnant fundoplication effectively controls reflux while maintaining bypass integrity. This report presents the first documented use of this technique in Saudi Arabia. Further research is needed to evaluate long-term outcomes and establish standardized guidelines.