REVISIONAL BARIATRIC SURGERY IN A PATIENT WITH ROUX-EN-Y GASTRIC BYPASS: LAPAROSCOPIC HIATAL HERNIA REPAIR WITH POSTERIOR CRURAL CLOSURE AND NISSEN FUNDOPLICATION USING THE GASTRIC REMNANT vilallongapuy@gmail.com

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REVISIONAL BARIATRIC SURGERY IN A PATIENT WITH ROUX-EN-Y GASTRIC BYPASS: LAPAROSCOPIC HIATAL HERNIA REPAIR WITH POSTERIOR CRURAL CLOSURE AND NISSEN FUNDOPLICATION USING THE GASTRIC REMNANT

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Gonzalo Sapisochin gonzalo.sapisochin@vallhebron.cat Hospital Universitari Vall d'Hebron General and Digestive Surgery Barcelona Spain

Spain

Video

Revisional bariatric surgery is the fastest-growing area in the field, mainly indicated for weight regain, complications from the primary procedure, or recurrence of metabolic disorders, reflecting the chronic and relapsing nature of obesity.

We present the case of a 48-year-old male with an initial BMI of 59 kg/m², who underwent a Roux-en-Y gastric bypass (RYGB) in 2017, achieving a nadir BMI of 21 kg/m². Despite successful weight loss, he developed several complications requiring multiple interventions: repair of Petersen’s hernia in 2019, revisional surgery in 2023 for gastrojejunal anastomosis reconstruction and hiatal hernia repair, and later surgery for an abdominal wall hematoma. Persistent gastroesophageal reflux disease (GERD) prompted a new revisional surgery in 2024. The surgical strategy involved posterior crural closure for hiatal repair combined with a Nissen fundoplication using the gastric remnant, adapted to the altered anatomy of the RYGB patient. This video demonstrates the technical aspects of this procedure.

The patient had an uneventful recovery, was discharged 72 hours postoperatively, and showed good clinical progress during outpatient follow-up. At six months, he remained asymptomatic for reflux and tolerated an oral diet without difficulty.

Nissen fundoplication using the gastric remnant represents an effective and safe revisional option for patients with prior RYGB, hiatal hernia, and GERD. Its technical simplicity, low complication profile, and significant improvement in patient quality of life highlight it as a valuable alternative, particularly in those with persistent reflux symptoms.

https://vimeo.com/1110572046/aefaf27a21