The “Hug” Technique – Roux-en-Y Gastric Bypass with preservation of 180 ° posterior fundoplication in patients with previous Nissen Fundoplication: a simple solution for a complex problem

Objectives: Laparoscopic conversion of Nissen Fundoplication to Roux-en-Y Gastric Bypass is a complex procedure related to increased operative times, morbidity and length of hospital stay (LOS). In this study, a new simplified technique avoiding the total dismanteling of the previous Nissen repair to construct the gastric pouch, the so called “Hug” Technique, is presented for conversion of Nissen Fundoplication to RYGB.

Methods: The present examination is a prospective single-center clinical series reporting on feasibility and safety of the “Hug” technique for laparoscopic Roux-en-Y gastric bypass (RYGB). The major innovation of this approach is the fact that the posterior part of the fundoplication wrap is left in place without further dissection or manipulation. The anterior part is stapled and remains attached to the excluded stomach. Prospective data on intraoperative and postoperative morbidity, reflux symptomatology and bariatric outcomes were collected.

Results: A total of 44 consecutive patients with a mean Body Mass Index (BMI) of 43.7 kg/m² (SD = 4.0, range = 35.6 – 52.0) underwent the “Hug” procedure between 2004 and 2015. Mean operative time was 72 min (58 – 105 min). Morbidity was low (4.5%), with no mortality. Reflux symptomatic dropped significantly without PPI medication, and mild asymptomatic endoscopic reflux was found in 12% of the patients.

Conclusion: In contrast to current techniques for bariatric surgery for patients having previously a Nissen fundoplication, the “Hug” procedure for RYGB is safe and simple to perform. The technique avoids the deconstruction of the previous repair and still maintaining an anti-reflux anatomy. Nevertheless, there is a need for further studies to evaluate the long-term outcomes of the procedure.