Hill procedure for recurrent GERD post-Roux-en-Y gastric bypass

Surgical Endoscopy
Radu PescarusKevin M Reavis

Abstract

Roux-en-Y gastric bypass (RYGB) is considered to be an optimal surgical treatment option for GERD in the morbidly obese patient. Nevertheless, a subgroup of patients suffer from recurrent or persistent GERD after their gastric bypass. Unfortunately, limited treatment options are available in these patients. Fundoplication via mobilization of the remnant stomach and radiofrequency treatment of the lower esophageal sphincter have been described with some success. Our objective is to illustrate a safe and durable surgical option in the treatment of patients with medically refractory GERD post-RYGB. After placing five trocars in the usual position for a foregut laparoscopic surgery, a lysis of adhesions and standard dissection of the hiatus is performed. The anterior and posterior vagal nerves associated phrenoesophageal tissue bundles are identified. A primary crural repair with interrupted nonabsorbable sutures is performed. Four full-length nonabsorbable sutures are placed sequentially through the anterior and posterior phrenoesophageal bundle, posterior fundus and finally through the pre-aortic fascia. The repair is calibrated on a 44 French bougie. The sutures are tied from medial to lateral in the order of their placement und...Continue Reading

Citations

Oct 4, 2016·Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery·Daniel GeroJean-Pierre Marmuse
Mar 27, 2020·Journal of Laparoendoscopic & Advanced Surgical Techniques. Part a·Fabio ButtiPierre Fournier
Aug 9, 2020·Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery·Pearl Ma, Kelvin Higa

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