Modified Nissen Fundoplication for Late Dumping Syndrome After Roux-en-Y Gastric Bypass.

INTRODUCTION: Postoperative dumping syndrome (DS) is a common complication after Roux-en-y gastric bypass (RYGB) for morbid obesity. DS is mostly treated conservatively through dietary or pharmacologic measures. In case of non-responding to or contraindication for conservative treatment, surgical intervention may be considered. Various procedures have been described, as there is currently no gold standard technique. We present a new approach by performing a modified Nissen fundoplication. CASE: A 34-year-old female consulted at our outpatient clinic. In her history, she had a laparoscopic RYGB 6 years earlier because of morbid obesity (BMI 37.6 kg/m2). Two years postoperatively, she developed a late DS, for which she was successfully treated with long-acting octreotide. Because of pregnancy wish, octreotide needed to be halted. A laparoscopic modified Nissen fundoplication was performed, creating a cuff around the oesophageal-gastric junction with the fundus of the remnant stomach. This slows down the passage of food through the gastric pouch. Postoperatively, the octreotide treatment was halted without any problems. At 6 months, the patient is still free of dumping complaints. DISCUSSION: Postoperative DS is a common complication after bariatric surgery. Dietary measures form the first treatment of DS, followed by pharmacologic treatment. Since octreotide is contraindicated in pregnancy, a surgical intervention was opted for. Our case is the first documented modified Nissen fundoplication to treat late postoperative DS after RYGB for morbid obesity.
CONCLUSION: A laparoscopic modified Nissen fundoplication could be a promising surgical alternative in the treatment of late dumping syndrome after RYGB for morbid obesity.