BACKGROUND Conversion of Nissen fundoplication to Roux-en-Y (RnY) anatomy may be indicated in patients with post-surgical complications or who fail to achieve durable control of their disease. Herein we describe the largest series of patients at a single institution who underwent minimally invasive conversion of Nissen fundoplication to RnY reconstruction. METHODS All patients with prior Nissen fundoplication which were converted to RnY anatomy at our institution from March 2009 through November 2017 were retrospectively reviewed and analyzed. Patients were identified based on CPT codes and the description of the operation performed. All cases with attempted minimally invasive approach were included for analysis. RESULTS Fifty patients underwent conversion from prior Nissen fundoplication to RnY anatomy during the study period. The cohort was 84.0% female with a mean age of 53.5 years and a median body mass index of 36.7 kg/m2. Thirteen patients (26.0%) had multiple prior foregut operations. Complications from fundoplication that warranted revision included recurrent hiatal hernia (n = 16), post-surgical gastroparesis (n = 10), and mechanical complications from the wrap (n = 8). An additional fourteen patients underwent conversion to RnY for metabolic disease. The mean operative time and estimated blood loss were 266 min and 132 mL, respectively, with all but one (98.0%) completed with a minimally invasive approach. The median length of stay was 5 days. Complications included marginal ulcer (n = 2), superficial surgical site infection (n = 2), anastomotic leak (n = 2), and one case each of pulmonary embolism, small bowel obstruction, and gastrointestinal bleeding. There were no mortalities at a median follow-up of 12.4 months. CONCLUSIONS Conversion of prior Nissen fundoplication to RnY anatomy is technically challenging, although it is safe and feasible even in the setting of multiple prior foregut operations. A minimally invasive approach should be offered to patients by surgeons with experience in revisional foregut and bariatric surgery.

中文翻译：

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尼森胃底折叠术失败后的抢救性手术-微创Roux-en-Y重建。

背景技术Nissen胃底折叠术可以转换为Roux-en-Y（RnY）解剖结构，适用于术后并发症或无法持久控制其疾病的患者。在这里，我们描述了在单个机构中经历了Nissen胃底折叠术向RnY重建的微创转化的最大系列患者。方法回顾性分析2009年3月至2017年11月在我院接受过Nissen胃底折叠术的所有患者，并将其转变为RnY解剖结构。根据CPT代码和所执行的手术说明识别患者。尝试微创治疗的所有病例均纳入分析。结果在研究期间，有50名患者经历了以前的Nissen胃底折叠术向RnY解剖学的转变。队列是84。0％的女性，平均年龄为53.5岁，平均体重指数为36.7 kg / m2。13名患者（26.0％）曾做过多次前肠手术。需翻修的胃底折叠并发症包括复发性食管裂孔疝（n = 16），术后胃轻瘫（n = 10）和包裹性机械并发症（n = 8）。另有十四名患者因代谢性疾病而转为RnY。平均手术时间和估计失血量分别为266分钟和132毫升，除一种以外（98.0％）的所有患者均采用微创方法完成。中位住院时间为5天。并发症包括边缘溃疡（n = 2），浅表外科手术部位感染（n = 2），吻合口漏（n = 2），以及肺栓塞，小肠梗阻和胃肠道出血各1例。中位随访时间为12.4个月，无死亡病例。结论将既往的Nissen胃底折叠术转换为RnY解剖学在技术上具有挑战性，尽管即使在进行多次前肠手术的情况下也是安全可行的。具有修订前肠和减肥手术经验的外科医生应为患者提供微创治疗方法。