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Published in:

01-08-2018

Roux-En-Y gastric bypass following failed fundoplication

Authors: Kathleen M. Coakley, Steven A. Groene, Paul D. Colavita, Tanushree Prasad, Dimitris Stefanidis, Amy E. Lincourt, Vedra A. Augenstein, Keith Gersin, B. Todd Heniford

Published in: Surgical Endoscopy | Issue 8/2018

Abstract

Introduction

Roux-En-Y gastric bypass (RYGB) is an alternative to reoperative fundoplication. The aim of this study was to expand long-term outcomes of patients undergoing RYGB after failed fundoplication and assess symptom resolution.

Methods

A single institution prospective study was performed of patients undergoing fundoplication takedown and RYGB between March 2007 and September 2016. Demographics, body mass index (BMI), preoperative symptoms, operative duration and findings, and postoperative outcomes were recorded. Data were assessed using standard statistical methods.

Results

87 patients with failed antireflux surgery underwent RYGB. Median age 58 years (range 25–79 years). Median preoperative BMI 32.4 kg/m² (range 21.6–50.6 kg/m²). Comorbidities included hypertension (48.3%) and diabetes (11.5%). Sixty-six patients had undergone 1 prior fundoplication, 18 had 2 prior fundoplications, and 3 had 3 prior fundoplications. At least one previous open antireflux procedure had been performed in 16.1% of patients. The most common recurrent symptoms were reflux (85.1%), dysphagia (36.7%), pain (35.6%), and regurgitation (29.9%). Median symptom-free interval from last antireflux surgery was 3 years (range 0–25 years). RYGB was performed laparoscopically in 47.1% of cases, robotically in 44.8% of cases, and open in 5.9%. Operative duration was longer in the robotic group (p = 0.04). During RYGB, 85.1% patients were found to have an associated hiatal hernia, 34.5% had intrathoracic migration of the fundoplication, 32.2% a slipped fundoplication onto proximal stomach, and 13.8% had wrap disruption. Median length of stay (LOS) was 4 days (range 1–33 days). Median follow-up was 35.8 months, 11 patients (12.6%) had recurrent reflux symptoms. Excess body weight loss (%EWL) was 80.4%. There was no mortality but 8 patients required reoperation during follow-up.

Conclusions

Fundoplication takedown with RYGB was successful for long-term reflux resolution. Most can be performed via a minimally invasive approach with acceptable perioperative morbidity, symptom resolution, and the additional benefit of %EWL.

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Title: Roux-En-Y gastric bypass following failed fundoplication
Authors: Kathleen M. Coakley
Steven A. Groene
Paul D. Colavita
Tanushree Prasad
Dimitris Stefanidis
Amy E. Lincourt
Vedra A. Augenstein
Keith Gersin
B. Todd Heniford
Publication date: 01-08-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 8/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-018-6072-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Roux-En-Y gastric bypass following failed fundoplication

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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