Abstract
Purpose
The aim of this work is to demonstrate a new concept of the surgical technique “FundoRing” for the prevention of acid and bile reflux esophagitis after gastric bypass.
Materials and Methods
A laparoscopic surgical technique of gastric bypass simultaneous with combined upper total and lower left partial fundoplication. This described case is a participant in an ongoing randomized clinical trial.
Results
The patient was without complications and was discharged on the third postoperative day. Delta BMI was 14 kg/m2 (38–24) at the 1-year follow-up. The patient did not have heartburn or bile reflux esophagitis after surgery. Evaluation of the mucosa of the esophagus by upper endoscopy after each of the 3 follow-up visits demonstrated that reflux esophagitis had resolved. Intraoperative fluorescence imaging technologies (NIR/ICG) (IMAGE1 S™ Rubina®) were to determine the quality of blood supply—no violation of the blood supply to the fundoplication wrap of the gastric pouch was detected. A CT scan clearly shows a fundoplication ring around the esophagus (two-thirds) and the upper part of the gastric pouch (one-third).
Conclusion
The surgical technique of primary modified fundoplication using the excluded stomach with simultaneous gastric bypass is feasible.
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Data Availability
Data and associated documentation will be available to users from the corresponding authors upon reasonable request.
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The conception of the project was by Oral Ospanov. He was the main surgeon responsible for video editing, and he wrote the abstract. The author reviewed the material in full and approved it before submission.
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The procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from participants included in the study.
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Key Points
• Primary fundoplication using an excluded stomach is easier than during revision surgery.
• The large length (5–6 cm) of the fundoplication wrap is a better option for gastric bypass.
• The suture of fundoplication wraps must orient to the stapler suture line on the gastric pouch.
• Double calibrated wrap: first at 1 o’clock and second at 3–4 o’clock creates a fundoplication ring.
Details on the trial: this randomized control trial (RCT) was conducted at Astana Medical University.
Trial registration: ClinicalTrials.gov, NCT04834635; registered 8 April 2021, https://clinicaltrials.gov/ct2/show/NCT04834635
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Ospanov, O. The Surgical Technique of Primary Modified Fundoplication Using the Excluded Stomach with Simultaneous Gastric Bypass. OBES SURG 33, 1311–1313 (2023). https://doi.org/10.1007/s11695-023-06505-6
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DOI: https://doi.org/10.1007/s11695-023-06505-6