Advertisement

Surgical Endoscopy

, Volume 22, Issue 12, pp 2737–2740 | Cite as

Laparoscopic revision of Nissen fundoplication to Roux-en-Y gastric bypass in morbidly obese patients

  • Kambiz Zainabadi
  • Anita P. Courcoulas
  • Omar Awais
  • Ioannis RaftopoulosEmail author
Dynamic Manuscript

Abstract

Background

We present a case of a morbidly obese patient with previous laparoscopic Nissen fundoplication (LNF) who was successfully treated by revision to a laparoscopic Roux-en-Y gastric bypass (RYGB) and discuss our collective experience.

Methods

Between June 2000 and April 2006 seven morbidly obese patients with mean body mass index (BMI) of 39.4 kg/m2 underwent laparoscopic revision of LNF to RYGB by our group. Important steps of the revision include lysis of all adhesions between the liver and the stomach, dissection of the diaphragmatic crura and gastroesophageal fat pad, reduction and repair of hiatal hernia and complete take-down of the wrap to avoid stapling over the fundoplication which can create an obstructed, septated pouch.

Results

There was one (14.3%) conversion. Mean operative time (OT) was 324 (206–419) minutes and length of stay was 4.9 (3–8) days. Early complications occurred in 3/7 (42.9%) patients including a staple line hemorrhage without a need for re-exploration, a small pulmonary embolism without hemodynamic instability and a small-bowel obstruction due to a pre-existing incisional ventral hernia that was not repaired on original operation. There were no anastomotic leaks or deaths. At a mean follow-up of 32.9 (12–39) months, mean percentage excess weight loss was 79.5% and 18/28 (64.3%) comorbid conditions were improved or resolved. Gastroesophageal reflux disease (GERD) evaluation with the GERD health-related quality of life (GERD-HRQL) scale showed a significant reduction of GERD scores postoperatively (16.7 versus 4.4).

Conclusions

Although laparoscopic RYGB after antireflux surgery is technically difficult and carries higher morbidity, it is feasible and effective in the treatment of recurrent GERD in morbidly obese patients.

Keywords

Bariatric Gastric bypass Laparoscopy Recurrent GERD Reoperative antireflux surgery Revision 

Supplementary material

(WMV 17464 kb)

References

  1. 1.
    Frezza EE, Ikramuddin S, Gourash W, Rakitt T, Kingston A, Luketich J, Schauer P (2002) Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass. Surg Endosc 16:1027–1031PubMedCrossRefGoogle Scholar
  2. 2.
    Perez AR, Moncure AC, Rattner DW (2001) Obesity adversely affects the outcome of antireflux operations. Surg Endosc 15:986–989PubMedCrossRefGoogle Scholar
  3. 3.
    Fraser J, Watson DI, O’Boyle CJ, Jamieson GG (2001) Obesity and its effect on outcome of laparoscopic Nissen fundoplication. Dis Esoph 14:50–53CrossRefGoogle Scholar
  4. 4.
    Patterson EJ, Davis DG, Khajanchee Y, Swanstrom LL (2003) Comparison of objective outcomes following laparoscopic Nissen fundoplication versus laparoscopic gastric bypass in the morbidly obese with heartburn. Surg Endosc 17:1561–1565PubMedCrossRefGoogle Scholar
  5. 5.
    Raftopoulos Y, Awais O, Fernando HC, Courcoulas AP, Luketich JD (2004) Laparoscopic gastric bypass after antireflux operations for the treatment of gastroesophageal reflux disease in morbidly obese patients. Initial experience. Obes Surg 14(10):1373–1380CrossRefGoogle Scholar
  6. 6.
    Velanovich V, Vallance SR, Gusz JR, Tapia FV, Harkabus MA (1996) Quality of life scale for gastroesophageal reflux disease. J Am Coll Surg 183:217–224PubMedGoogle Scholar
  7. 7.
    Houghton SG, Nelson LG, Swain JM et al (2005) Is Roux-en-Y gastric bypass safe after previous antireflux surgery? Technical feasibility and postoperative symptom assessment. Surg Obes Relat Dis 1:475–480PubMedCrossRefGoogle Scholar
  8. 8.
    Kellogg TA, Andrade R, Maddaus M, Slusarek B, Buchwald H, Ikramuddin S (2007) Anatomic findings and outcomes after antireflux procedures in morbidly obese patients undergoing laparoscopic conversion to Roux-en-Y gastric bypass. Surg Obes Relat Dis 3:52–57PubMedCrossRefGoogle Scholar
  9. 9.
    Oelschlager BK, Lal DR, Jensen E, Cahill M, Quiroga E, Pellegrini CA (2006) Medium- and long-term outcome of laparoscopic redo fundoplication. Surg Endosc Oct 9; [Epub ahead of print]Google Scholar
  10. 10.
    Raftopoulos I (2007) Comparison of selective clipping vs. routine oversewing of the gastric remnant staple line on postoperative hemorrhage after laparoscopic Roux-en-Y gastric bypass. A prospective non-randomized comparison trial. Accepted for presentation at the 24th Annual meeting of the American Society for Bariatric Surgery, San Diego, CA, June 11–16Google Scholar
  11. 11.
    Schauer P, Ikramuddin S (2001) Laparoscopic surgery for morbid obesity. Surg Clin North Am 81:1145–1181PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Kambiz Zainabadi
    • 1
  • Anita P. Courcoulas
    • 1
  • Omar Awais
    • 2
  • Ioannis Raftopoulos
    • 3
    Email author
  1. 1.Division of Minimally Invasive, Bariatric and General Surgery, UPMC Shadyside & Magee-Women’s HospitalsUniversity of PittsburghPittsburghUSA
  2. 2.Heart, Lung and Esophageal Surgery InstituteUniversity of Pittsburgh Medical CenterPittsburghUSA
  3. 3.Department of SurgeryBariatric Center at St. Francis Hospital and Medical CenterHartfordUSA

Personalised recommendations