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Introduction: Conversion of Fundoplication to Roux-en-Y gastric bypass (RYGB) results in significant weight loss and resolution of co-morbid illness, especially gastrointestinal reflux disease (GERD). This procedure offers alternative therapy to patients with recalcitrant GERD following a failed fundoplication. To date, very little long-term data exists for this revisional procedure.
Materials and Methods: Patients who underwent a conversion of fundoplication (Nissen or other) to RYGB between 2000 and 2011 at our academic medical center were identified. The department's bariatric surgery database was reviewed for weight loss, the presence of GERD symptoms and the use of GERD medications. A reflux and heartburn questionnaire was administered to assess impact on quality of life (GERD-HRQL) scores and to determine postoperative GERD symptoms.
Results: Twenty eight patients (female/male = 24/4) underwent laparoscopic (n=17) or open (n=11) surgery by 3 different surgeons and mean weight follow-up (100%) was 3 ½ years. Average preoperative BMI and weight were 43.1 kg/m2 and 119 kg; 3 patients had BMI below 35 kg/m2. Average length of stay was 4 days. Post-revisional BMI, weight, and % excess weight loss were 32.0 kg/m2, 87 kg, and 61%. Resolution of type II diabetes mellitus, hypertension, and hyperlipidemia were noted in 67%, 33%, and 60% of patients, respectively. No major short-term complications occurred and there were no mortalities. At least 13 patients (46%) continued to use daily acid reduction medication treatment, and 7 patients reported ongoing GERD symptoms (25%). Indications for GERD therapy also include nonspecific abdominal pain, pre-RYGB history of Barrett's esophagitis, and documented gastrojejunal ulcer. On a ranked scale of no symptoms (0) to incapacitating symptoms (50), mean GERD-HRQL score was 9.5/ 50 following surgery.
Conclusion: Conversion of fundoplication to RYGB is performed on patients with a lower than average BMI than our typical RYGB cohort and experience significant weight loss with improvement in comorbid disease. Complications are similar to larger cohorts of patients undergoing RYGB. Although ongoing therapy for acid reduction is common, improvements in GERD symptoms were noted.