Abstract
Background:
Gastroesophageal reflux disease (GERD) after a Roux-en-Y gastric bypass (RYGB) is not uncommon. 1 Most cases are managed by proton pump inhibitors (PPIs) and changes in lifestyle. 2,3 This video shows the laparoscopic management of resistant reflux in a patient following a RYGB despite adequate non-operative treatment.
Methods:
A 42-year-old female patient who had RYGB 3 years ago and lost 70% of the excess weight presented with refractory GERD. Her current BMI was 31 kg/m2 with no comorbidities and no risk factors for reflux such as smoking, alcohol, or medications. Gastroscopy, barium study, pH, and manometry were consistent with a hiatal hernia, severe reflux, esophagitis, and mild dysmotility. Based on the hiatal hernia, a surgical approach was recommended.
At laparoscopy, the adhesions were divided, and the hiatus was circumferentially dissected. A hiatal hernia was identified, and the gastric pouch was reduced. Approximately 3 cm of intraabdominal esophagus was obtained. The hernia defect was repaired, and the excluded stomach was used to buttress the hiatal repair and act as a posterior 180-degree wrap.
Results:
The patient was discharged on postoperative day 2 with no adverse events. The reflux was controlled with no post-operative PPI medications at 3 months. The patient did not undergo post-operative EGD or UGI series but remains asymptomatic.
Conclusions:
Good short-term results for GERD can be achieved by reducing a hiatal hernia after a RYGB if a hiatal defect is present. Long-term follow-up is needed in these patients. The contribution of the excluded stomach may simply buttress the hiatal repair as opposed to an anti-reflux mechanism, but this may not be directly measured without pH monitoring or an UGI.
Ethics Approval:
All procedures performed in studies involving human participants 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.
Informed Consent:
Taken from the patient at time of surgery.
“Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure”.
None of the authors have any competing financial interests
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Runtime of video:
8 min:1 sec.
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