Heartburn, Acid Reflux and Nissen Fundoplication Revision
Janice from the Houston Galleria area sent us this question: I had a fundoplication because of so much acid. It worked for a few years. About 7 years ago, I was told that it had come undone. I want to have a gastric sleeve because of medical problems and being obese. Will it be possible?
Dear Janice,
Conversion of loose or failed Nissen fundoplication to sleeve gastrectomy along with redo hiatal hernia repair is possible and safe. Obesity, especially central or visceral obesity, is associated with increased intra-abdominal pressure and increased risk of metabolic disorders such as diabetes, sleep apnea and hypertension. Increased intra-abdominal pressure along with overeating and stretching of the stomach weakens the fundoplication and may lead with time to fundoplication failure. Revision surgery consists of unwrapping the fundoplication and resecting the gastric fundus along the rest of the greater curvature to create the gastric sleeve. I cannot over stress the importance of hiatal hernia repair in this situation to reliably stop acid reflux. A sleeve gastrectomy in the presence of a normal lower esophageal sphincter resting pressure is as good as Nissen fundoplication in stopping acid reflux. If the lower esophageal sphincter pressure is low, then conversion to gastric bypass may be a better acid reflux procedure. Pre-operative esophageal manometry to study esophagus motility and sphincter pressure is an important test prior to choosing the right surgical revision. Weight loss following failed Nissen to sleeve conversion further contributes to acid reflux control as well eliminating other obesity related comorbidities.