DESCRIPTION A 46-year-old light woman presented to the medical center in September 2009 with intermittent abdominal epigastric pain accompanied by nausea heartburn and frequent crises of asthma and cough for one year. submitted to laparoscopic adhesiolysis for small bowel obstruction. In September 2009 her weight decreased to 75.6 kg (166.3 lbs) which corresponded to a BMI of 26.79 (28% weight loss). Abdominal ultrasound and computed tomography ruled out any pancreatic or hepatobiliary disease. As the patient’s symptoms did not improve despite extended trials of antacids and double doses of proton-pump inhibitors for over a year investigations with 24-h esophageal pH monitoring (24-h pH testing) and manometry were NVP-TAE 226 conducted. A new upper endoscopy post-RYGB revealed a patent gastrojejunostomy (Figure 2A) in addition to grade B Los Angeles reflux esophagitis with 10-mm longitudinal mucosal breaks (Figure 2B) and no signs of eosinophilic esophagitis. There was no evidence of hiatal herniation or Barrett’s esophagus. Predicated on a 24-h pH check performed to fundoplication the DeMeester rating was 67 prior.8 mmHg with acid reflux disorder occurring higher than 10% of that time period both in supine (42.3%) and straight (16.9%) positions. The DeMeester reflux rating was 67.8 (normal <14.72 95 percentile). Manometry demonstrated a lesser esophageal sphincter pressure (LES) of 9 mmHg (regular range between 14.3 to 34.5 mmHg) as well as the contraction amplitude from the proximal and middle area was higher than 30 mmHg (50.6 mmHg). A biopsy demonstrated quality 2 esophagitis. The top gastrointestinal (GI) series exposed proper emptying from NVP-TAE 226 the gastric pouch but free of charge gastroesophageal reflux disease (GERD). Which means administration NVP-TAE 226 of intractable postoperative reflux was performed having a laparoscopic 360° Rabbit polyclonal to SHP-1.The protein encoded by this gene is a member of the protein tyrosine phosphatase (PTP) family.. fundoplication to bolster the low esophageal sphincter by wrapping the excluded abdomen around the cheapest part of the esophagus. This system is not described. Hiatal restoration and dissection were performed as NVP-TAE 226 well as the crura were approximated with 3 interrupted 2.0 polypropylene sutures. The excluded abdomen was thoroughly isolated and utilized to create the fundoplication as well as the brief gastric vessels had been divided utilizing the harmonic scalpel through the inferior pole from the spleen towards the superior facet of the excluded abdomen. A loose brief 3-cm cover was designed with assessment from the z-line (Shape 1C) performed under endoscopic assistance (Shape 1D). A 32-Fr intra-esophageal bougie was also utilized to calibrate the wrap. The excluded stomach (approximately 6 cm) was passed behind the esophagus and the anterior and posterior excluded stomach lips were sutured together with three interrupted 3.0 polypropylene sutures (Figure 1E). The muscular wall of the anterior esophagus was incorporated in the sutures while carefully avoiding injury to the anterior vagus nerve. The fundoplication was not anchored to the crura. Reflux symptoms were scored using the Visick classification and a validated GERD questionnaire published elsewhere (1) before and after fundoplication (six months post-operation). There was marked improvement of preoperative symptoms and well-being in the post-operatory period (change in Visick classification from 3 to 1 1 and change in reflux symptoms score from 33 to 2). The patient tolerated the operation with no complications and experienced successful resolution of GERD symptoms. She was discharged on postoperative day two tolerating a liquid diet without reflux or dysphagia. We were able to compare 24-h pH testing and manometry pre- and post-operatively. The erosion near the gastrojejunostomy (Figure 2C) healed after the surgery. She continues to be asymptomatic without reflux or dysphagia six months later. Figure NVP-TAE 226 1 The proposed technique: A – Surgical anatomy post-RYGB. B – Surgical anatomy post-fundoplication. The LES was reinforced by wrapping the excluded stomach around the lowest portion of the esophagus. C – Endoscopic view of the 3.5-cm pouch as well as the 13-mm … Shape 2 Pre – and intraoperative endoscopic look at during laparoscopic fundoplication post-RYGB for weight problems. A- Patent GJ. Transillumination from the jejunum using the laparoscope could be noticed. B – Quality B LA reflux esophagitis (10-mm longitudinal … Dialogue To our understanding this is actually the 1st referred to case of abdominal anti-reflux medical procedures (ARS) performed by laparoscopy in the past due postoperative period pursuing bariatric medical procedures. Bypass provides superb long-term control of GERD symptoms and gets the additional good thing about weight reduction (2). Despite optimized medical therapy because the mainstay treatment GERD.