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Revisional One-Anastomosis Gastric Bypass (OAGB) After Intrathoracic Migration of Nissen Fundoplication

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Abstract

According to the latest IFSO recommendations, bariatric and metabolic surgery is the recommended treatment for patients with a BMI above 35 kg/m2 (with or without associated pathology), achieving good results in terms of weight loss in the medium to long term, as well as improving a significant percentage of comorbidities in this type of patient (diabetes mellitus, arterial hypertension, dyslipidaemia, gastro-esophageal reflux disease (GERD)...). The incidence of GERD is higher in patients with obesity, with more severe symptoms. Over the years, Nissen fundoplication has been the gold standard treatment for patients with GERD who do not respond to medical treatment. However, in patients with obesity, gastric bypass is a valid option to consider. We present the case of a patient who had previously undergone anti-reflux surgery (laparoscopic Nissen) for GERD, with favorable evolution, who presented intrathoracic migration of the same after 8 years, with new onset of symptoms, and who was offered revision bariatric surgery. The video presents on the performance of OAGB in a patient who had previously undergone antireflux surgery, with intrathoracic Nissen. Performing this technique after a previous Nissen fundoplication (as well as migration of the Nissen) is a somewhat more complex procedure than primary surgery but can be performed safely with careful technique (there are often previous adhesions that hinder mobility and separation of the fundoplication) and provides good symptom control.

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Authors and Affiliations

  1. Department of General Surgery, Torrecárdenas University Hospital, C/ Hermandad Donantes de Sangre S/N, 04009, Almería, Spain

    Manuel Ferrer-Márquez, Manuel García-Redondo & Francisco Rubio-Gil

  2. Department of Bariatric Surgery (Obesidad Almería), General Surgery, Hospital Mediterráneo, Almería, Spain

    Manuel Ferrer-Márquez, Francisco Rubio-Gil & Manuel Ferrer-Ayza

  3. Department of Bariatric Surgery (Obesidad Almería), Hospital Mediterráneo, Almería, Spain

    María José Torrente-Sánchez

Authors
  1. Manuel Ferrer-Márquez
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  2. Manuel García-Redondo
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  3. Francisco Rubio-Gil
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  4. María José Torrente-Sánchez
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  5. Manuel Ferrer-Ayza
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Corresponding author

Correspondence to Manuel García-Redondo.

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Key points

- OAGB after Nissen fundoplication is a safe procedure.

- Revisional surgery after intrathoracic migration of a fundoplication requires a careful and precise technique.

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Ferrer-Márquez, M., García-Redondo, M., Rubio-Gil, F. et al. Revisional One-Anastomosis Gastric Bypass (OAGB) After Intrathoracic Migration of Nissen Fundoplication. OBES SURG 33, 1951–1952 (2023). https://doi.org/10.1007/s11695-023-06611-5

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  • DOI: https://doi.org/10.1007/s11695-023-06611-5

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