Bariatric operations have been shown to provide excellent relief from gastroesophageal reflux disease symptoms in morbidly obese patients. Unfortunately, some of these patients have undergone previous antireflux procedures. The altered anatomy and adhesions encountered often make revisional surgery technically challenging and may increase the risk for perioperative morbidity. This video details our approach to the revision of a prior laparoscopic Nissen fundoplication to a Roux-En-Y gastric bypass with Stamm gastrostomy.

Our patient is a 46 year old morbidly obese female with hypertension, obstructive sleep apnea on CPAP, GERD, and a BMI of 41.6 who had previously undergone a laparoscopic Nissen fundoplication. She presented to our clinic requesting weight loss surgery as a means of controlling her multiple comorbidities including her recurrent GERD symptoms. The key steps of each part of the procedure are provided visually with running narration. This includes recognition of an ischemic end to the jejunojejunostomy requiring resection as well as resection of the effected prior fundoplication.

The patient did very well postoperatively and remains free of GERD symptoms upon follow-up in clinic.

Laparoscopic revision to Roux-En-Y gastric bypass is a reasonable option in morbidly obese patients who have undergone previous antireflux procedures including Nissen fundoplication. Careful attention to lysis of adhesions while maintaining blood supply to the residual stomach and resection of marginal or ischemic portions of the prior fundoplication are essential aspects of this operation.