• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

Laparoscopic Fundoplication Takedown With Roux-en-Y Gastric Bypass Leads to Excellent Reflux Control and Quality of Life in Patients After One Or More Failed Fundoplications

Fernando A Navarro, MD, Brant T Heniford, Keith Gersin, Dimitrios Stefanidis. Carolinas Medical Center, Division of Gastrointestinal and Minimally Invasive Surgery, Charlotte, NC

 

 

 

 

Introduction: Recent data suggest that redo fundoplication after prior failed fundoplication (FP) is associated with a high failure rate to control reflux in the long term. In this patient population, a laparoscopic Roux-en-Y gastric bypass (LRYGB) may be a better option for long term reflux control, especially in the obese, but outcome and quality of life data are sparse. Our aim was to assess outcomes and quality of life data after fundoplication takedown and LRYGB for patients with failed fundoplications.

Methods: The records of 25 patients who underwent fundoplication takedown and LRYGB between March 2007 and July 2011 were reviewed. Patient demographics, body mass index (BMI), preoperative symptoms, operative duration and findings, length of stay (LOS), Estimated Blood loss (EBL), length of follow up (FU) and postoperative outcomes were recorded. The Gastrointestinal Quality of Life Index (GIQLI) and the Gastrointestinal Symptoms Rating Scale (GSRS) were used at the latest follow up to assess symptom severity and quality of life.

Results: Patient age was 55 (36-72) years, BMI 34.4 (22-50) kg/m2, and 22 were women (88%). Heartburn (100%), dysphagia (40 %), regurgitation (32 %), and chest pain (15 %) were the most common preoperative symptoms. Comorbidities included; Diabetes, hypertension, sleep apnea, osteoarthritis, coronary artery disease, arthritis. Symptom free interval since last surgery was 5.2 (1-25) years. Patients had undergone a total of 40 prior antireflux surgeries, 41 % via an open approach. Operative duration was 345 (180-600) minutes, LOS 7 (2-30) days, and EBL 181 (50-500) ml. A slipped FP was found in 10 patients (40%), wrap disruption in 9 patients (36%), 3 patients had a combination of these, and one had a herniation of an intact wrap. Twenty three (92%) patients had an associated hiatal hernia. There was no mortality but 11 patients (44%) had complications and five required a reoperation. At 14 (1-48) months FU excess weight loss was 60% and comorbidity resolution 68 %. 24 (96%) patients were free of reflux with a mean postoperative GIQLI score of 114 (80-135) and a GSRS score of 25 (17-45). Twenty four patients (96%) reported being much happier with their physical appearance, more energetic and more able to take part in recreational and leisure activities. Fifteen patients (62%) believed that their personal relations and sexual life were better than before their LRYGBP. Twenty four patients (96%) were satisfied with their outcome and would undergo the surgery again. There were no quality of life differences between obese and non-obese patients.

Conclusions: Patients who undergo LRYGBP after failed fundoplication(s) have excellent control of their reflux and excellent quality of life and high satisfaction rates with their outcome. Nevertheless, the procedure is challenging and associated with considerable morbidity and should be undertaken by surgeons experienced in antireflux and bariatric surgery. Longer term outcomes of this procedure and comparison to outcomes of redo fundoplication are needed to better document its value for this challenging and high risk patient population.


Session Number: SS09 – Obesity Surgery
Program Number: S051

976

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons