Laparoscopic Roux-en-Y Gastric Bypass After Nissen Fundoplication Preserving Wraps Integrity
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LETTER TO THE EDITOR
Laparoscopic Roux-en-Y Gastric Bypass After Nissen Fundoplication Preserving Wraps Integrity Patricia Ahechu 1 & Fernando Rotellar 1,2 & Victor Valenti 1,2,3,4
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Dear Editor, We have read with great interest the article “Bariatric surgery after previous antireflux surgery without takedown of the previous fundoplication: a prospective study” [1] and its recent Letter to the Editor and Letter to the Editor reply [2, 3]. We would like to congratulate the Editors-in-Chief of the Journal and authors of the articles for the excellent discussion and interesting contributions. Since we have also worked on the same subject recently, we would like to further the discussion of this current topic with a review of the literature and video description of the essential aspects of our modified technique for laparoscopic Roux-en-Y gastric bypass (LRYGB) with preservation of the wraps after previous Nissen fundoplication (LNF). As has been very well addressed in the previous studies, LRYGB has been reported to be a feasible and effective treatment in morbidly obese patients who have previously Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04705-y) contains supplementary material, which is available to authorized users. * Victor Valenti [email protected]; https://www.cun.es/enfermedades-tratamientos/ tratamientos/cirugia-bariatrica Patricia Ahechu [email protected] Fernando Rotellar [email protected] 1
Department of Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Pamplona, Spain
2
CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Pamplona, Navarra, Spain
3
Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
4
Department General Surgery, University Clinic of Navarra, Avenida Pio XII 36, 31008 Pamplona, Navarra, Spain
undergone laparoscopic antireflux surgery, although it is technically demanding and has a higher morbidity [4–7]. We have recently reviewed all available series on this topic and, indeed, most of the literature reviewed indicates the need for the takedown of the fundoplication as first step towards successful surgery. Kelloggs et al. [8] justify the need for the takedown of the fundoplication before construction of the gastric pouch to avoid oversizing the pouch and to promote the exclusion of acid-producing parietal cells. Zainabadi et al. [4] and Stefanidis et al. [5] report the risk of stapling over the fundoplication and creating an obstructed and septated pouch. They also promote the routine removal of the gastric remnant fundus, because it often appears ischemic and is easily injured during fundoplication takedown, thus minimizing the incidence of missed perforations after surgery [5]. Finally, Hougthon et al. [6] and Raftopoulos et al. [7] suggest that the dissection and takedown of a previous fundoplication, combined with ligation of t
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