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

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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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References

  1. Sturm R. Increases in clinically severe obesity in the United States, 1986-2000. Arch Intern Med. 2003;163(18):2146–8.

    Article  PubMed  Google Scholar 

  2. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004 Oct 13;292(14):1724–37.

    Article  CAS  PubMed  Google Scholar 

  3. World Health Organization. World Health Report 2002. Available at: http://www.who.int/whr/2002/en/. Accessed November 1, 2016

  4. Smith KB; Smith MS. Obesity statistics. Prim Care. 43(1):121–135, 2016 Mar.

  5. Nelson LG, Gonzalez R, Haines K, et al. Amelioration of gastroesophageal reflux symptoms following Roux-en-Y gastric bypass for clinically significant obesity. Am Surg. 2005;71(11):950–3. discussion 3-4

    PubMed  Google Scholar 

  6. Kindel TL, Oleynikov D. The improvement of gastroesophageal reflux disease and Barrett’s after bariatric surgery. Obes Surg. 2016;26(4):718–20.

    Article  PubMed  Google Scholar 

  7. Kim M, Navarro F, Eruchalu CN, et al. Minimally invasive Roux-en-Y gastric bypass for fundoplication failure offers excellent gastroesophageal reflux control. Am Surg. 2014;80(7):696–703.

    PubMed  Google Scholar 

  8. Pallati PK, Shaligram A, Shostrom VK, et al. Improvement in gastroesophageal reflux disease symptoms after various bariatric procedures: review of the bariatric outcomes longitudinal database. Surg Obes Relat Dis. 2014;10(3):502–7.

    Article  PubMed  Google Scholar 

  9. Houghton SG, Romero Y, Sarr MG. Effect of Roux-en-Y gastric bypass in obese patients with Barrett’s esophagus: attempts to eliminate duodenogastric reflux. Surg Obes Relat Dis. 2008;4(1):1–4. discussion 1-5

    Article  PubMed  Google Scholar 

  10. Naik RD, Choksi YA, Vaezi MF. Impact of weight loss surgery on esophageal physiology. Gastroenterol Hepatol (N Y). 2015;11(12):801–9.

    Google Scholar 

  11. Grover BT, Kothari SN. Reoperative antireflux surgery. Surg Clin North Am. 2015;95(3):629–40.

    Article  PubMed  Google Scholar 

  12. Makris KI, Panwar A, Willer BL, et al. The role of short-limb Roux-en-Y reconstruction for failed antireflux surgery: a single-center 5-year experience. Surg Endosc. 2012;26(5):1279–86.

    Article  PubMed  Google Scholar 

  13. Stefanidis D, Navarro F, Augenstein VA, et al. Laparoscopic fundoplication takedown with conversion to Roux-en-Y gastric bypass leads to excellent reflux control and quality of life after fundoplication failure. Surg Endosc. 2012;26(12):3521–7.

    Article  PubMed  Google Scholar 

  14. Zainabadi K, Courcoulas AP, Awais O, et al. Laparoscopic revision of Nissen fundoplication to Roux-en-Y gastric bypass in morbidly obese patients. Surg Endosc. 2008;22(12):2737–40.

    Article  PubMed  Google Scholar 

  15. Houghton SG, Nelson LG, Swain JM, et al. Is Roux-en-Y gastric bypass safe after previous antireflux surgery? Technical feasibility and postoperative symptom assessment. Surg Obes Relat Dis. 2005;1(5):475–80.

    Article  PubMed  Google Scholar 

  16. Kellogg TA, Andrade R, Maddaus M, et al. Anatomic findings and outcomes after antireflux procedures in morbidly obese patients undergoing laparoscopic conversion to Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007;3(1):52–7.

    Article  PubMed  Google Scholar 

  17. Mehaffey JH, DJ LP, Clement KC, et al. 10-year outcomes after Roux-en-Y gastric bypass. Ann Surg. 2015a;264(1):121–6.

    Article  Google Scholar 

  18. Mehaffey JH, LaPar DJ, Turrentine FE, et al. Outcomes of laparoscopic Roux-en-Y gastric bypass in super-super-obese patients. Surg Obes Relat Dis. 2015b;11(4):814–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22903, USA

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

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  1. Michael D Watson
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  2. J. Hunter Mehaffey
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  3. Bruce D. Schirmer
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  4. Peter T. Hallowell
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Correspondence to Peter T. Hallowell.

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Conflicts of Interest

The authors declare that they have no conflict of interest.

Source of Funding

The National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number T32HL007849 supported research reported in this publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study. This study was approved by our institution’s Institutional Review Board (IRB# 17132). A prospectively collected database approved by the Institutional Review Board (IRB# 17132) at our institution of all patients undergoing weight loss surgery was queried.

Statement of Human Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Watson, M.D., Hunter Mehaffey, J., Schirmer, B.D. et al. Roux-en-Y Gastric Bypass Following Nissen Fundoplication: Higher Risk Same Reward. OBES SURG 27, 2398–2403 (2017). https://doi.org/10.1007/s11695-017-2643-4

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  • DOI: https://doi.org/10.1007/s11695-017-2643-4

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