Surgical treatment of therapy-resistant reflux after Roux-en-Y gastric bypass. A case series of the modified Nissen fundoplication

Abstract

Introduction: Patients with intractable reflux after RYGB have limited treatment options. Here a modified Nissen fundoplication (MNF) as described by N. Kawahara might be the answer.

Methods: In this retrospective case study we identified six patients with therapy-resistant GERD after RYGB. All six were treated with a MNF, using the remnant stomach to construct the fundoplication. Short term follow-up 1 month and 6–12 months postoperatively was conducted to inquire about GERD symptoms.

Results: Six patients underwent a MNF. Three out of six patients had had a gastric band in their medical history. Upper GI barium swallow test revealed herniation of the gastric pouch in 4/6 patients. After surgery all patients were symptom free and 4/6 completely stopped PPI treatment.

Discussion: Mechanisms of new onset or deteriorating GERD after RYGB are herniation of gastric pouch and destruction of the lower esophageal sphincter after banding. Both problems are tackled when constructing a MNF.

Conclusion: Complete symptom relief was seen 1 month after MNF. The procedure seems safe, feasible and effective. The study is limited by small sample size and short follow-up yet shows clear improvement of symptoms. Larger trials are needed to establish validity of the MNF.

Keywords:

• Gastro-esophageal reflux
• Roux-en-Y gastric bypass
• Nissen fundoplication
• modified Nissen fundoplication
• GERD
• obesity

Notes

Disclosure statement

None of the authors have any conflict of interest to declare.

Notes

1 At least one PPI 2 times 40mg daily, whether or not associated with antacids. 

2 Low-dose PPI’s = 20 to 40 mg omeprazole or pantoprazole daily