# Gastric remnant fundoplication for refractory GERD post-roux-en-Y gastric bypass: A case report

## TL;DR

A patient with persistent acid reflux after weight-loss surgery was successfully treated with a new surgical technique using the remaining stomach tissue.

## Contribution

This is the first reported use of gastric remnant fundoplication for refractory GERD after RYGB in Saudi Arabia.

## Key findings

- Gastric remnant fundoplication resolved symptoms of refractory GERD after RYGB.
- Traditional fundoplication is not feasible post-RYGB due to altered anatomy.
- The procedure preserved the bypass anatomy while restoring anti-reflux function.

## Abstract

Gastroesophageal reflux disease (GERD) commonly affects individuals with obesity, often worsened by increased intra-abdominal pressure and hiatal hernias. Roux-en-Y gastric bypass (RYGB) is preferred for obese patients with GERD due to its effectiveness in weight loss and symptom relief, but some patients experience persistent or recurrent GERD post-surgery. In cases resistant to medical treatment, additional surgical intervention may be required. This case report described using the gastric remnant for fundoplication in patients with refractory GERD after RYGB.

A 48-year-old female with obesity and GERD underwent RYGB with concurrent hiatal hernia repair. Despite initial improvement, she developed treatment-resistant GERD. Endoscopy revealed esophagitis and bile reflux. Due to the severity of her symptoms, a revisional surgery was performed using the gastric remnant for fundoplication, leading to complete symptom resolution postoperatively.

Managing GERD post-RYGB is challenging when medical therapy fails. Traditional fundoplication is unfeasible due to the absence of a gastric fundus. Alternative approaches, such as Hill's repair, ligamentum teres cardiopexy, and magnetic sphincter augmentation, have uncertain long-term efficacy. Gastric remnant fundoplication offers a promising solution by restoring the anti-reflux mechanism while preserving bypass anatomy.

Refractory GERD after RYGB is a significant challenge. Gastric remnant fundoplication effectively controls reflux while maintaining bypass integrity. This report presents the first documented use of this technique in Saudi Arabia. Further research is needed to evaluate long-term outcomes and establish standardized guidelines.

•Refractory GERD may persist or recur even after Roux-en-Y gastric bypass (RYGB).•Traditional fundoplication is not feasible post-RYGB due to altered anatomy.•Gastric remnant fundoplication is a novel, anatomy-preserving solution.•This is the first reported case of this technique in Saudi Arabia.•The procedure resulted in full symptom resolution within 3 months.

Refractory GERD may persist or recur even after Roux-en-Y gastric bypass (RYGB).

Traditional fundoplication is not feasible post-RYGB due to altered anatomy.

Gastric remnant fundoplication is a novel, anatomy-preserving solution.

This is the first reported case of this technique in Saudi Arabia.

The procedure resulted in full symptom resolution within 3 months.