The impact of previous fundoplication on laparoscopic gastric bypass outcomes: a case-control evaluation

Abstract

Gastroesophageal reflux disease (GERD) is a common comorbid condition in morbidly obese gastric bypass candidates. Unfortunately, some patients who ultimately present for bariatric surgery have previously undergone Nissen fundoplication for GERD. Many surgeons consider previous fundoplication to be a relative contraindication to subsequent laparoscopic Roux-en-Y gastric bypass (LRYGB) due to increased technical complexity and risk. We sought to compare the perioperative and long-term outcomes of a cohort of patients who had first undergone fundoplication and ultimately chose to later pursue LRYGB for morbid obesity (revision) to matched control patients. Data were obtained from our prospectively maintained bariatric surgery database. Patients who underwent laparoscopic takedown of a previous fundoplication and conversion to LRYGB were compared to control patients who underwent primary LRYGB. For every revision patient, two control subjects were randomly selected from the database after matching for preoperative body mass index and year of surgery. From July 2002 to April 2011, 14 patients underwent laparoscopic takedown of a previous Nissen fundoplication and then underwent LRYGB. During the same interval, 673 patients underwent LRYGB as a primary procedure for obesity from which 28 were selected as controls. There were no conversions to open laparotomy in any patient. Subjects were similar demographically. Operating time and duration of hospital stay were significantly longer in revision patients. Complications were more frequent in revisions (36% revisions vs. 7% controls, P=0.03). Excess weight loss 1-year after surgery was excellent in both groups and did not differ (69% revision vs. 69.6% controls, P=0.93). Although associated with longer operating times, longer duration of hospital stay, and complications, LRYGB after fundoplication is feasible and safe. Long-term weight loss outcomes are similar to those seen following primary LRYGB. Previous fundoplication is not a contraindication to LRYGB.