Response to “Letter to the Editor” in regard to the article: “Bariatric Surgery After Previous Antireflux Surgery Without Takedown of The Previous Fundoplication: A Prospective Study”
We have read with great interest the letter concerning our article “Bariatric Surgery After Previous Antireflux Surgery Without Takedown of The Previous Fundoplication: A Prospective Study.” We thank the authors for their suggestions.
Our study aims to demonstrate the feasibility, without postoperative surgical complications, of obesity surgery without takedown of the previous fundoplication. It is a non-randomized prospective study analyzed by the the intention-to-treat. After the appropriate literature review, we found only few studies addressing this topic. We provide further evidences against the misplaced dogma to do "complete wrap unfolding" during any bariatric procedure.
We agree with the authors’ claim that “Primary gastric bypass has a major morbidity rate of around 1%, contrary to the 2 fold stated increase, this value increased up to 20 fold in patients with a previous anti-reflux repair.” On the other hand, we have not determined the superiority of the Roux-en-Y gastric bypass. We have just provided one more argument that “bariatric surgery is possible after fundoplication without taking down the fundoplication. It appears to be a feasible alternative for patients seeking weight loss surgery after fundoplication.”
We agree with the authors’ reasoning that gastroesophageal reflux disease (GERD) is an important aspect in determining in the choice of technique/approach. Indeed, in case of absence of (GERD), which testifies to the efficacy of the previous Fundoplication, we have opted to do a sleeve gastrectomy, while a gastric bypass has been performed in patients with (GERD) despite the previous fundoplication. Large-scale studies are needed to validate these conclusions.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
Statement of Informed Consent Human and Animal Rights
Informed consent was obtained from all individual participants included in the study.