FUNDOPLICATION CONVERSION IN ROUX-EN-Y GASTRIC BYPASS FOR CONTROL OF OBESITY AND GASTROESOPHAGEAL REFLUX: SYSTEMATIC REVIEW. 2017

Antônio Moreira Mendes-Filho, and Eduardo Sávio Nascimento Godoy, and Helga Cristina Almeida Wahnon Alhinho, and Manoel Dos Passos Galvão-Neto, and Almino Cardoso Ramos, and Álvaro Antônio Bandeira Ferraz, and Josemberg Marins Campos
Post-Graduation Program in Surgery, Federal University of Pernambuco, Recife, PE.

BACKGROUND Obesity is related with higher incidence of gastroesophageal reflux disease. Antireflux surgery has inadequate results when associated with obesity, due to migration and/or subsequent disruption of antireflux wrap. Gastric bypass, meanwhile, provides good control of gastroesophageal reflux. OBJECTIVE To evaluate the technical difficulty in performing gastric bypass in patients previously submitted to antireflux surgery, and its effectiveness in controlling gastroesophageal reflux. METHODS Literature review was conducted between July to October 2016 in Medline database, using the following search strategy: ("Gastric bypass" OR "Roux-en-Y") AND ("Fundoplication" OR "Nissen ') AND ("Reoperation" OR "Reoperative" OR "Revisional" OR "Revision" OR "Complications"). RESULTS Were initially classified 102 articles; from them at the end only six were selected by exclusion criteria. A total of 121 patients were included, 68 women. The mean preoperative body mass index was 37.17 kg/m² and age of 52.60 years. Laparoscopic Nissen fundoplication was the main prior antireflux surgery (70.58%). The most common findings on esophagogastroduodenoscopy were esophagitis (n=7) and Barrett's esophagus (n=6); the most common early complication was gastric perforation (n=7), and most common late complication was stricture of gastrojejunostomy (n=9). Laparoscopic gastric bypass was performed in 99 patients, with an average time of 331 min. Most patients had complete remission of symptoms and efficient excess weight loss. CONCLUSIONS Although technically more difficult, with higher incidence of complications, gastric bypass is a safe and effective option for controlling gastroesophageal reflux in obese patients previously submitted to antireflux surgery, with the added benefit of excess weight loss.

UI MeSH Term Description Entries
D009765 Obesity A status with BODY WEIGHT that is grossly above the recommended standards, usually due to accumulation of excess FATS in the body. The standards may vary with age, sex, genetic or cultural background. In the BODY MASS INDEX, a BMI greater than 30.0 kg/m2 is considered obese, and a BMI greater than 40.0 kg/m2 is considered morbidly obese (MORBID OBESITY).
D012086 Reoperation A repeat operation for the same condition in the same patient due to disease progression or recurrence, or as followup to failed previous surgery. Revision, Joint,Revision, Surgical,Surgery, Repeat,Surgical Revision,Repeat Surgery,Revision Surgery,Joint Revision,Revision Surgeries,Surgery, Revision
D005764 Gastroesophageal Reflux Retrograde flow of gastric juice (GASTRIC ACID) and/or duodenal contents (BILE ACIDS; PANCREATIC JUICE) into the distal ESOPHAGUS, commonly due to incompetence of the LOWER ESOPHAGEAL SPHINCTER. Esophageal Reflux,Gastro-Esophageal Reflux Disease,GERD,Gastric Acid Reflux,Gastric Acid Reflux Disease,Gastro-Esophageal Reflux,Gastro-oesophageal Reflux,Gastroesophageal Reflux Disease,Reflux, Gastroesophageal,Acid Reflux, Gastric,Gastro Esophageal Reflux,Gastro Esophageal Reflux Disease,Gastro oesophageal Reflux,Gastro-Esophageal Reflux Diseases,Reflux Disease, Gastro-Esophageal,Reflux, Gastric Acid,Reflux, Gastro-Esophageal,Reflux, Gastro-oesophageal
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D015390 Gastric Bypass Surgical procedure in which the STOMACH is transected high on the body. The resulting small proximal gastric pouch is joined to any parts of the SMALL INTESTINE by an end-to-side SURGICAL ANASTOMOSIS, depending on the amounts of intestinal surface being bypasses. This procedure is used frequently in the treatment of MORBID OBESITY by limiting the size of functional STOMACH, food intake, and food absorption. Gastroileal Bypass,Gastrojejunostomy,Greenville Gastric Bypass,Roux-en-Y Gastric Bypass,Bypass, Gastric,Bypass, Gastroileal,Bypass, Roux-en-Y Gastric,Gastric Bypass, Greenville,Gastric Bypass, Roux-en-Y,Gastrojejunostomies,Roux en Y Gastric Bypass
D018662 Fundoplication Mobilization of the lower end of the esophagus and plication of the fundus of the stomach around it (fundic wrapping) in the treatment of GASTROESOPHAGEAL REFLUX that may be associated with various disorders, such as hiatal hernia. (From Dorland, 28th ed) Nissen Operation,Operation, Nissen

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