Julia from Humble sent us this question:
“If one is not a candidate for a Nissen Fundoplication due to poor motility and a previous Nissen, would it be possible to have Roux-en-Y gastric bypass surgery to alleviate reflux?
Thank you.”
Dear Julia,
At Houston Heartburn and Reflux Center, very few acid reflux patients are not candidates for Nissen fundoplication, the gold standard treatment for GERD. Weak motility and previous Nissen fundoplication surgery are not absolute contraindications for Nissen fundoplication surgery. Indeed, most acid reflux patients have poor esophageal motility due to longstanding GERD. Esophageal motility improves after Nissen fundoplication and stopping acid reflux. Certain patients, however, have severe esophageal dysmotility with ineffective swallows on manometry and poor bolus clearance. In such cases, a partial fundoplication is preferred to avoid post-operative dysphagia. If a GERD patient is obese with a BMI more than 40 then weight loss surgery in the form of Roux-en-Y gastric bypass or sleeve gastrectomy is preferred over fundoplication. Weight loss surgery results in significant weight loss that helps control acid reflux. Nissen fundoplication in the setting of morbid obesity and constantly elevated intra-abdominal/ intra-gastric pressure, tends to fail over time. Another indication for Roux-en-Y gastric bypass surgery is poor gastric fundus tissue following multiple Nissen fundoplication revisions. At this stage, there is not much gastric fundus to work with to properly construct a fundoplication. The only option left is to resect gastric fundus and convert t0 gastric bypass.
Last but not least, revision acid reflux surgery requires a competent and skilled acid reflux specialist and surgeon to achieve best outcome. Decisions have to properly made based on clear and comprehensive evaluation to achieve success and avoid complications.