Conversion of Nissen Fundoplication to RY Gastric Bypass in a Morbidly Obese Patient Without Wrap Taken Down

Background: The association between gastroesophageal reflux disease (GERD) and obesity with a prevalence of 50-100% has been proven, while 8-26% of non-obese patients experienced GERD. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the gold standard for obese patients with GERD. RYGB can accelerate gastric emptying and thus improve reflux symptoms. Case presentation: A 56-year-old man weighing 101 kg and 167 cm tall (BMI 36.2) presented to the hospital with major complaints of obesity and mild gastroesophageal reflux disease. He also suffered from comorbidities like DM, HTN, and IHD. 15 years ago he underwent Nissen Fundoplication due to severe GERD. We candidate the patient for LRYGB surgery because of obesity, Mild reflux, and comorbidities such as DM, and HTN. Due to past fundoplication, severe adhesions, and fibrosis at the last operation site, LRYGB without Wrap taken down was done. Discussion: Laparoscopic conversion of Fundoplication to RYGB is a complex technique because of extended operative time, morbidity, and length of hospital stay. RYGBP after fundoplication leads to more complications than other forms of reoperative bariatric surgery; however, it gives a good weight loss that satisfies the patient. Conclusion: LRYGB after previous anti-reflux surgery without wrap takedown is technically safe and brings in reflux symptoms and comorbidities improvement, satisfactory weight loss, and less morbidity.