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A Technique of Preserving Preexisting Fundoplication When Converting to Roux-en-Y Gastric Bypass

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Abstract

Background

The standard surgical treatment of gastro-esophageal reflux disease (GERD) consists of either 360° (Nissen, NFP) or 270° (Toupet, TFP) fundoplication. On some occasions, such as recurrent GERD and/or severe overweight, patients may benefit from conversion to Roux-en-Y gastric bypass (RYGB), which is however technically difficult. Most techniques of conversion involve unwrapping of the fundoplication. We developed a laparoscopic technique that includes preservation of the wrap, while constructing a standard small-pouch RYGB. We describe the surgical technique and report the short-term outcomes of our technique.

Methods

Consecutive patients underwent conversion of NFP to RYGB by our fundoplication preserving technique as described in surgical technique. Perioperative outcomes were assessed by analysis of the electronic patient records; progression of GERD symptoms and patient satisfaction were evaluated by an on-line questionnaire.

Results

Fourteen patients underwent the conversion. There were no peroperative complications and no conversions. Short-term complications were registered in 4 patients (Clavien-Dindo grade 1, n = 2; grade 2, n = 1 and grade 3a, n = 1). No long-term complications were reported. None of the participants reported significant GERD symptoms Patient satisfaction was good.

Conclusion

We developed a laparoscopic technique of NFP to RYGB conversion, with preservation of fundoplication integrity, which appears to add to the safety and efficacy of the procedure.

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Authors and Affiliations

  1. Department of Visceral Surgery, Delta CHIREC Hospital, 201, Boulevard du Triomphe, 1160, Brussels, Belgium

    Anne-Catherine Dandrifosse & Jacques Himpens

Authors
  1. Anne-Catherine Dandrifosse
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  2. Jacques Himpens
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Corresponding author

Correspondence to Jacques Himpens.

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Ethics Approval

All procedures in this study 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. All efforts were undertaken to preserve the privacy of the participants (GDPR regulations).

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The authors declare no competing interests.

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Key Points

- Conversion of Nissen or Toupet fundoplication to Roux-en-Y gastric bypass has a high complication incidence when fundoplication is dismantled.

- Preserving the fundoplication appears to be beneficial in terms of short-term complications.

- Preserving the fundoplication may be beneficial in terms of avoiding gastro-esophageal reflux.

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Dandrifosse, AC., Himpens, J. A Technique of Preserving Preexisting Fundoplication When Converting to Roux-en-Y Gastric Bypass. OBES SURG 32, 2914–2920 (2022). https://doi.org/10.1007/s11695-022-06185-8

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  • DOI: https://doi.org/10.1007/s11695-022-06185-8

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