NISSEN FUNDOPLICATION TO RYGB REVISION

Service Description

🔄 Nissen Fundoplication to RYGB Revision Revising a Nissen Fundoplication to a Roux-en-Y Gastric Bypass (RYGB) is a well-established and technically complex revisional surgery. It is often performed when chronic gastroesophageal reflux disease (GERD), dysphagia, or failed fundoplication persists despite the original anti-reflux procedure. What is Nissen Fundoplication? A Nissen fundoplication is a 360° wrap of the gastric fundus around the lower esophagus to reinforce the lower esophageal sphincter, typically performed to treat GERD. While effective initially, failure rates after 10 years reach up to 30–50%, especially in obese patients. ❌ Why Convert to Roux-en-Y Gastric Bypass? - Recurrent or persistent GERD: Acid or bile reflux returns post-fundoplication - Dysphagia or gas bloat syndrome: Due to a tight or slipped wrap - Wrap herniation or disruption: Common long-term mechanical complication - Obesity or weight regain: Fundoplication doesn’t cause weight loss - Barrett’s esophagus or esophagitis: Refractory or worsening with GERD recurrence What Does the Revision Involve? 1. Take down the Nissen wrap - This requires meticulous dissection, as fibrosis and scarring are usually present. 2. Create a small gastric pouch - Usually fashioned proximal to the former wrap. 3. Construct the Roux-en-Y Bypass - Alimentary limb: Carries food from the pouch - Biliopancreatic limb: Diverts bile and pancreatic secretions - Jejunojejunostomy completes the Roux configuration ✅ Benefit and Why It Matters - Strong GERD control: RYGB is the gold standard for reflux in obese patients - Eliminates bile reflux: Reconfigured anatomy diverts bile from esophagus - Addresses obesity: Provides restriction + malabsorption for weight loss - Improves esophagitis: Reduces acid and bile exposure - Lowers Barrett’s progression risk: By managing reflux more effectively ⚠️ Risks and Challenges - Dense adhesions: Due to prior surgery and inflammation - Leak risk: Especially at the pouch and anastomosis - Prolonged OR time: Often >3 hours depending on scarring - Higher technical demand: Requires advanced surgical expertise - Nutritional deficiencies: Requires lifelong supplementation and follow-up