Role of Roux-en-Y for Remedial Anti-reflux Surgery

Initial treatment for failed anti-reflux surgery includes medical management, lifestyle changes and endoscopic dilation. Redo fundoplication may be necessary for intractability. With the effectiveness of Roux-en-Y gastric bypass for obesity, we have also noticed significant improvement in reflux, suggesting a relationship between reflux and obesity. With the ongoing obesity epidemic, we have observed a higher incidence of obese patients with failed anti-reflux surgery. In this subset of patients, Roux-en-Y is emerging as a favored surgical approach for remedial anti-reflux surgery. In this review we identify crucial factors to consider, describe our surgical technique and evaluate outcomes after conversion to Roux-en-Y.