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Redo fundoplication vs. Roux-en-Y gastric bypass conversion for failed anti-reflux surgery: which is better?

  • 2023 SAGES Oral
  • Published:
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Abstract

Introduction

Different techniques have been proposed for reoperation after failed anti-reflux surgery. However, there is no consensus on which should be preferred. We aim to report and compare the outcomes of different revisional techniques for failed anti-reflux surgery.

Methods

We performed a retrospective analysis of patients who underwent redo fundoplication (RF) or Roux-en-Y gastric bypass (RYGB) conversion after a failed fundoplication at our institution between 2016 and 2021. The primary outcome was long-term presence of reflux or dysphagia following revisional surgery. Secondary outcomes included 30-day perioperative complications as well as long-term use of anti-reflux medication and radiographic recurrence of hiatal hernia (HH).

Results

A total of 165 (median age 63 years, 73.9% female) patients were included. RF was performed in 120 (73 Toupet and 47 Nissen), RYGB in 38, and 7 patients had fundoplication takedown alone. The RYGB group had a significantly higher BMI, and more prior revisional surgeries compared to the other groups. Median operative time and length of stay were longer for RYGB. Twenty (12.1%) patients experienced postoperative complications, with the highest incidence in the RYGB group. Reflux and dysphagia improved significantly for the whole cohort, with the greatest improvement noted with reflux in the RYGB group (89.5% with preoperative reflux vs. 10.5% with postoperative reflux, p =  < .001). On multivariable regression we found that prior re-operative surgery was associated with persistent reflux and dysphagia, whereas RYGB conversion was protective against reflux.

Conclusion

Conversion to RYGB may offer superior resolution of reflux than RF, especially for obese patients.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of General Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA

    Rocio Castillo-Larios, Naga Swati Gunturu, Jorge Cornejo, Spencer W. Trooboff, Steven P. Bowers & Enrique F. Elli

  2. Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA

    Abhishek Ramgir Giri

Authors
  1. Rocio Castillo-Larios
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  2. Naga Swati Gunturu
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  3. Jorge Cornejo
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  4. Spencer W. Trooboff
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  5. Abhishek Ramgir Giri
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  6. Steven P. Bowers
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  7. Enrique F. Elli
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Corresponding author

Correspondence to Enrique F. Elli.

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Disclosures

Drs. Rocio Castillo-Larios, Naga Swati Gunturu, Jorge Cornejo, Spencer W. Trooboff, Abhishek Ramgir Giri, Steven P. Bowers and Enrique F. Elli have no conflicts of interest or financial ties to disclose.

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Castillo-Larios, R., Gunturu, N.S., Cornejo, J. et al. Redo fundoplication vs. Roux-en-Y gastric bypass conversion for failed anti-reflux surgery: which is better?. Surg Endosc 37, 6429–6437 (2023). https://doi.org/10.1007/s00464-023-10074-1

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  • DOI: https://doi.org/10.1007/s00464-023-10074-1

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