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Obesity Surgery
Published in: Obesity Surgery 9/2017

01-09-2017 | Original Contributions

Roux-en-Y Gastric Bypass Following Nissen Fundoplication: Higher Risk Same Reward

Authors: Michael D Watson, J. Hunter Mehaffey, Bruce D. Schirmer, Peter T. Hallowell

Published in: Obesity Surgery | Issue 9/2017

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Abstract

Background

Roux-en-Y gastric bypass (RYGB) effectively treats obesity and gastroesophageal reflux disease (GERD). As more surgeons recommend RYGB to treat GERD in patients with obesity, there are concerns about this approach in patients with previous non-bariatric foregut surgery. This study aims to evaluate the effect of previous non-bariatric foregut surgery on subsequent RYGB.

Methods

Retrospective review of 2089 patients undergoing RYGB between January 1985 and June 2015 was conducted to identify all patients with previous non-bariatric foregut surgery. Perioperative and postoperative data was collected by retrospective chart review.

Results

A total of 11 patients with prior non-bariatric foregut surgery underwent RYGB with median time between operations of 95.6 months. Of note, 7/11 (63.6%) had previous Nissen fundoplication. Conversion to open operation was required in 3/7 (42.9%) with previous Nissen compared to 1/4 (25%) in those without previous Nissen. The average length of stay (LOS) was 3.9 ± 0.9 days, significantly longer than our institutional average for RYGB of 3.2 ± 3.2 days (p = 0.02). Mean percentage of excess body mass index loss (%EBMIL) was 64.7 ± 23.5 at 4-year median follow-up, comparable to our institution’s previously reported data. No mortalities were attributed to RYGB and the overall complication rate was 18.2%, compared to our institutional complication rate for RYGB of 8.5% (p = 0.253).

Conclusion

Despite increased technical difficulty and increase perioperative morbidity, patients undergoing RYGB with previous non-bariatric foregut surgery had long-term symptom resolution and robust weight loss. This indicates that in the right hands, RYGB after non-bariatric foregut surgery may be performed safely and effectively.
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Metadata
Title
Roux-en-Y Gastric Bypass Following Nissen Fundoplication: Higher Risk Same Reward
Authors
Michael D Watson
J. Hunter Mehaffey
Bruce D. Schirmer
Peter T. Hallowell
Publication date
01-09-2017
Publisher
Springer US
Published in
Obesity Surgery / Issue 9/2017
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-017-2643-4

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