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. 2017 Sep;27(9):2398-2403.
doi: 10.1007/s11695-017-2643-4.

Roux-en-Y Gastric Bypass Following Nissen Fundoplication: Higher Risk Same Reward

Michael D Watson  1 , J Hunter Mehaffey  1 , Bruce D Schirmer  1 , Peter T Hallowell  2
Affiliations

Roux-en-Y Gastric Bypass Following Nissen Fundoplication: Higher Risk Same Reward

Michael D Watson et al. Obes Surg. 2017 Sep.

Abstract

Background: Roux-en-Y gastric bypass (RYGB) effectively treats obesity and gastroesophageal reflux disease (GERD). As more surgeons recommend RYGB to treat GERD in patients with obesity, there are concerns about this approach in patients with previous non-bariatric foregut surgery. This study aims to evaluate the effect of previous non-bariatric foregut surgery on subsequent RYGB.

Methods: Retrospective review of 2089 patients undergoing RYGB between January 1985 and June 2015 was conducted to identify all patients with previous non-bariatric foregut surgery. Perioperative and postoperative data was collected by retrospective chart review.

Results: A total of 11 patients with prior non-bariatric foregut surgery underwent RYGB with median time between operations of 95.6 months. Of note, 7/11 (63.6%) had previous Nissen fundoplication. Conversion to open operation was required in 3/7 (42.9%) with previous Nissen compared to 1/4 (25%) in those without previous Nissen. The average length of stay (LOS) was 3.9 ± 0.9 days, significantly longer than our institutional average for RYGB of 3.2 ± 3.2 days (p = 0.02). Mean percentage of excess body mass index loss (%EBMIL) was 64.7 ± 23.5 at 4-year median follow-up, comparable to our institution's previously reported data. No mortalities were attributed to RYGB and the overall complication rate was 18.2%, compared to our institutional complication rate for RYGB of 8.5% (p = 0.253).

Conclusion: Despite increased technical difficulty and increase perioperative morbidity, patients undergoing RYGB with previous non-bariatric foregut surgery had long-term symptom resolution and robust weight loss. This indicates that in the right hands, RYGB after non-bariatric foregut surgery may be performed safely and effectively.

Keywords: Bariatric; GERD; Nissen fundoplication; Roux-en-Y gastric bypass (RYGB).

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Conflict of interest statement

Conflicts of Interest

There are no financial disclosures or conflicts of interest from any of the authors.

Statements of Conflict of Interest

Author 1: no conflict of interest

Author 2: no conflict of interest. The National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number T32HL007849 supported research reported in this publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author 3: no conflict of interest

Author 4: no conflict of interest

References

    1. Sturm R. Increases in clinically severe obesity in the United States, 1986–2000. Arch Intern Med. 2003;163(18):2146–8. - PubMed
    1. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004 Oct 13;292(14):1724–37. - PubMed
    1. World Health Organization. [Accessed November 1, 2016];World Health Report. 2002 Available at: http://www.who.int/whr/2002/en/
    1. Smith KB, Smith MS. Obesity Statistics. Prim Care. 2016 Mar;43(1):121–35. ix. - PubMed
    1. Nelson LG, Gonzalez R, Haines K, Gallagher SF, Murr MM. Amelioration of gastroesophageal reflux symptoms following Roux-en-Y gastric bypass for clinically significant obesity. Am Surg. 2005;71(11):950–3. discussion 3–4. - PubMed

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