Skip to main content
SpringerLink
Log in

From Nissen Fundoplication to Roux-en-Y Gastric Bypass to Treat Both GERD and Morbid Obesity

  • Multimedia Article
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Gastroesophageal reflux disease (GERD) is common in obese individuals in around 30%. While fundoplication is the treatment of choice in non-obese individuals with GERD resistant to medical treatment, the laparoscopic Roux-en-Y gastric bypass (LRYGB) is the most effective option in the setting of morbid obesity to treat at the same time both GERD and obesity.

Methods

We present the case of a 31-year-old woman with a BMI of 37 kg/m2 who underwent an open Nissen fundoplication in 2010 and surgical revision in 2012 with redo of the Nissen fundoplication. She consulted for dysphagia and obesity complicated by invalidating arthrosis. A barium swallow showed esophageal dilatation and cardial stenosis. Manometry revealed incomplete waves and high pressure at the lower esophageal sphincter. We decided to convert the Nissen fundoplication to Roux-en-Y gastric bypass (RYGB).

Results

In this video, we show how to revise Nissen fundoplication to RYGB. The intervention starts by complete dissection of the gastric valve and the hiatal region from right to left. Then, a short gastric pouch is created taking care to exclude the gastric fundus that is also partially resected. We perform a hand-sewn gastro-jejunal anastomosis slightly larger than for conventional bypass. A RYGB with 50-cm bilio-pancreatic and 150-cm alimentary limb is then performed.

Conclusions

Conversion of Nissen fundoplication to RYGB allows treatment of dysphagia, which may represent a complication of the fundoplication, and is effective for management obesity and GERD. In this video we show important technical steps of this procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Thereaux J, Roche C, Bail JP. Conversion of Nissen fundoplication to laparoscopic gastric bypass: video case report and literature review. Surg Obes Relat Dis. 2015;11:973–4.

    Article  Google Scholar 

  2. Adil MT, Al-Taan O, Rashid F, et al. A systematic review and meta-analysis of the effect of Roux-en-Y gastric bypass on Barrett’s esophagus. Obes Surg. 2019; https://doi.org/10.1007/s11695-019-04083-0.

    Article  Google Scholar 

  3. Kristo I, Paireder M, Jomrich G, et al. Modern esophageal function testing and gastroesophageal reflux disease in morbidly obese patients. Obes Surg. 2019 Jun 14; https://doi.org/10.1007/s11695-019-04020-1.

    Article  Google Scholar 

  4. Chang P, Friedenberg F. Obesity and GERD. Gastroenterol Clin North Am. 2014;43(1):161–73. https://doi.org/10.1016/j.gtc.2013.11.009.

    Article  PubMed  Google Scholar 

  5. Engel LS, Chow WH, Vaughan TL, et al. Population attributable risks of esophageal and gastric cancers. J Natl Cancer Inst. 2003;95(18):1404–13.

    Article  Google Scholar 

  6. Raj PP, Bhattacharya S, Misra S, et al. Gastroesophageal reflux-related physiologic changes after sleeve gastrectomy and Roux-en-Y gastric bypass: a prospective comparative study. Surg Obes Relat Dis. 2019; https://doi.org/10.1016/j.soard.2019.05.017.

    Article  Google Scholar 

  7. Sebastianelli L, Benois M, Vanbiervliet G, et al. Systematic endoscopy 5 years after sleeve gastrectomy results in a high rate of Barrett’s esophagus: results of a multicenter study. Obes Surg. 2019;29(5):1462–9. https://doi.org/10.1007/s11695-019-03704-y.

    Article  PubMed  Google Scholar 

  8. Ibele A, Garren M, Gould J. The impact of previous fundoplication on laparoscopic gastric bypass outcomes: a case-control evaluation. Surg Endosc. 2012;26:177–81.

    Article  Google Scholar 

  9. 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;80:696–703.

    PubMed  Google Scholar 

  10. Biter LU, van Buuren MMA, Mannaerts GHH, et al. Quality of life 1 year after laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass: a randomized controlled trial focusing on gastroesophageal reflux disease. Obes Surg. 2017 Oct;27(10):2557–65. https://doi.org/10.1007/s11695-017-2688-4.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea Hospital, Rome, Italy

    Niccolo’ Petrucciani

  2. Université Côte d’Azur, Nice, France

    Lionel Sebastianelli, Sébastien Frey & Antonio Iannelli

  3. Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France

    Lionel Sebastianelli, Sébastien Frey & Antonio Iannelli

  4. Inserm, U1065, Team 8 “Hepatic complications of obesity and alcohol”, Nice, France

    Antonio Iannelli

  5. Service de Chirurgie Digestive et Centre de Transplantation Hépatique, Hôpital Archet 2, 151 Route Saint Antoine de Ginestière, 3079, Nice Cedex3, BP, France

    Antonio Iannelli

Authors
  1. Niccolo’ Petrucciani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lionel Sebastianelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sébastien Frey
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Antonio Iannelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonio Iannelli.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Statement of Human and Animal Rights

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

(MP4 114511 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Petrucciani, N., Sebastianelli, L., Frey, S. et al. From Nissen Fundoplication to Roux-en-Y Gastric Bypass to Treat Both GERD and Morbid Obesity. OBES SURG 30, 790–792 (2020). https://doi.org/10.1007/s11695-019-04271-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-019-04271-y

Keywords

Search

Navigation