Background

Although gastroesophageal reflux disease (GERD) often goes into remission after Roux-en-Y gastric bypass (RYGB), some patients can experience GERD post-operatively, either from acid reflux or Roux stasis. When GERD is refractory to medical management after RYGB, especially in context of a hiatal hernia, surgical intervention may be required. We present a video of gastric remnant fundoplication with concurrent redo paraesophageal hernia repair after RYGB in a patient with refractory GERD.Case

Methods

A 60-year-old female with a history of a RYGB and subsequent paraoesophageal hernia repair, presented with GERD refractory to maximal medical therapy. Preoperatively she underwent upper endoscopy which revealed reflux esophagitis as well as a recurrence of a hiatal hernia with most of the gastric pouch in the mediastinum. Upper endoscopy demonstrated pouch hiatal hernia and spontaneous reflux. She underwent a laparoscopic paraoesophageal hernia repair with 360-degree gastric remnant fundoplication with uneventful recovery. At 6-month postoperative visit she had no symptoms on once daily proton pump inhibitor, no dysphagia, and was very satisfied with the outcome.

Conclusions

Laparoscopic gastric remnant fundoplication is a feasible intervention in patients with refractory GERD after gastric bypass. Preoperative studies may consist of upper endoscopy, pH studies, esophageal manometry, and/or upper gastrointestinal series. This complex procedure should be performed under experienced hands at facilities with trained bariatric surgeons.