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Surgical Endoscopy

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01-01-2012

The impact of previous fundoplication on laparoscopic gastric bypass outcomes: a case-control evaluation

Authors: Anna Ibele, Michael Garren, Jon Gould

Published in: Surgical Endoscopy | Issue 1/2012

Abstract

Background

Gastroesophageal reflux disease (GERD) is a common comorbid condition in morbidly obese gastric bypass candidates. Unfortunately, some patients who ultimately present for bariatric surgery have previously undergone Nissen fundoplication for GERD. Many surgeons consider previous fundoplication to be a relative contraindication to subsequent laparoscopic Roux-en-Y gastric bypass (LRYGB) due to increased technical complexity and risk. We sought to compare the perioperative and long-term outcomes of a cohort of patients who had first undergone fundoplication and ultimately chose to later pursue LRYGB for morbid obesity (revision) to matched control patients.

Methods

Data were obtained from our prospectively maintained bariatric surgery database. Patients who underwent laparoscopic takedown of a previous fundoplication and conversion to LRYGB were compared to control patients who underwent primary LRYGB. For every revision patient, two control subjects were randomly selected from the database after matching for preoperative body mass index and year of surgery.

Results

From July 2002 to April 2011, 14 patients underwent laparoscopic takedown of a previous Nissen fundoplication and then underwent LRYGB. During the same interval, 673 patients underwent LRYGB as a primary procedure for obesity from which 28 were selected as controls. There were no conversions to open laparotomy in any patient. Subjects were similar demographically. Operating time and duration of hospital stay were significantly longer in revision patients. Complications were more frequent in revisions (36% revisions vs. 7% controls, P = 0.03). Excess weight loss 1-year after surgery was excellent in both groups and did not differ (69% revision vs. 69.6% controls, P = 0.93).

Conclusions

Although associated with longer operating times, longer duration of hospital stay, and complications, LRYGB after fundoplication is feasible and safe. Long-term weight loss outcomes are similar to those seen following primary LRYGB. Previous fundoplication is not a contraindication to LRYGB.

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Title: The impact of previous fundoplication on laparoscopic gastric bypass outcomes: a case-control evaluation
Authors: Anna Ibele
Michael Garren
Jon Gould
Publication date: 01-01-2012
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 1/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-011-1851-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The impact of previous fundoplication on laparoscopic gastric bypass outcomes: a case-control evaluation

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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