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.

Laparoscopic Sleeve Gastrectomy in Patients with Left Ventricular Assist Device-Case Series and Review of Literature.

For patients with advanced heart failure, left ventricular assist device (LVAD) can serve as a bridge to heart transplantation. Patients with class II obesity are eligible for implantation of LVAD but do not meet criteria for cardiac transplant listing. Laparoscopic sleeve gastrectomy (LSG) is proposed as weight losing modality in order to reach the New York Heart Association (NYHA) criteria for listing. In our center, three patients on LVAD with need for weight-reducing therapy were treated with laparoscopic sleeve gastrectomy. We reviewed our data retrospectively and compared it with the literature. Successful weight loss was achieved in all patients, without postoperative adverse events. Two out of three were listed on transplant waiting list. Our results are similar to those described in other series.