Laparoscopic Roux-en-Y Gastric Bypass After Nissen Fundoplication Preserving Wraps Integrity
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LETTER TO EDITOR/LED REPLY
Laparoscopic Roux-en-Y Gastric Bypass After Nissen Fundoplication Preserving Wraps Integrity Pierre Blanc 1 & Christophe Breton 1 & Radwan Kassir 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
We thank the authors for this careful reading of our article and their comments. The long-term outcome of a residual gastric fundus remains unknown (gastroesophageal reflux disease [GERD], weight regain). The residual gastric fundus used to perform the valve may result in less weight loss and faster weight regain. The figure 1 in our article [1] shows that the antireflux valve is voluminous when the small blood vessels are preserved. In practice, it is very likely that the gastric pouch was small (unrecovered operative reports). Nevertheless, the weight regains after bariatric surgery also depend on the patient’s eating behavior, adapted physical activity, and morale [2]. The risk of weight regain exists regardless of the surgery, because the entire gastric pouch dilates in the medium term [3]. In France, the medico-legal risk is significant [4]. The risk of complications is higher in the case of surgical revision [5]. If the dissection of the hiatus is delicate, our attitude is not to perform a takedown of the previous fundoplication. Concerning the GERD, indeed, with our technique, the risk of appearance/aggravation of a GERD is not negligible. However, the risk of a post-sleeve GERD is not insignificant. Nevertheless, this risk depends on other factors, notably the persistence of obesity at the time of surgery and the presence of Helicobacter pylori infection [6]. In conclusion, bariatric surgery after antireflux surgery without dismantling the valve is maybe not optimal in terms of weight loss and GERD; however, our technique
* Radwan Kassir [email protected] 1
Department of Bariatric Surgery, Clinique Chirurgicale Mutualiste de Saint-Etienne, Saint-Étienne, France
2
Department of Bariatric Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France
is a safe alternative which surgeons should be aware of when the repeated approach to the hiatus is difficult.
Compliance with Ethical Standards Conflict of Interest The authors declare that they have no conflict of interest. Statement of Informed Consent Informed consent was obtained from all individual participants included in the study. Statement of Human and Animal Rights Informed consent was obtained from all individual participants included in the study.
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Kassir R, Lointier P, Breton C, et al. Bariatric surgery after previous antireflux surgery without takedown of the previous fundoplication: a prospective study. Obes Surg. 2020;30(2):423–6. https://doi.org/ 10.1007/s11695-019-04180-0. Kassir R, Blanc N, Tiffet O, et al. Obesity and the stool concept. Obes Surg. 2015;25(1):129–30. https://doi.org/10.1007/s11695014-1405-9. Mahawar KK, Graham Y, Carr WR, et al. Revisional Roux-en-Y gastric bypass and sleeve gastrectomy: a systematic review of comparative outcomes with respe
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