Laparoscopic Modified Nissen Fundoplication over Roux-En-Y Gastric Bypass and Hiatal hernia repair for Intractable Gastroesophageal Reflux
Roux-en-Y gastric bypass (RYGB) is an effective treatment for morbid obesity and gastroesophageal reflux disease (GERD) 1. Despite majority of patients with resolution of GERD after RYGB, some patients will continue to complain of significant, persistent reflux symptomatology or develop de novo symptoms despite aggressive medical management. It ’s true incidence is unknown and one study showed an improvement in GERD but not resolution in 22% of patients after RYGB with GERD2. Possible mechanisms may include primary lower esophageal sphincter incompetence, disruption of the angle of His or development of hiatal hernia with intrathoracic m igration of the gastric pouch.