title: Residual fundus or neofundus after laparoscopic sleeve gastrectomy: is fundectomy safe and effective as revision surgery?
abstract: BACKGROUND
  Up to 30 % of patients who have undergone laparoscopic sleeve gastrectomy require revision surgery for inadequate weight loss, weight regain, and/or the development of severe upper gastrointestinal symptoms. The aim of this retrospective study was to evaluate the safety and efficacy of laparoscopic fundectomy (LF) in cases of a residual fundus/neofundus development regarding GERD symptoms.
  
  
  METHODS
  The study group comprised 19 patients (17 female; mean BMI 35.4 kg/m(2)) divided into 2 groups. Group A (n = 10) patients with severe GERD and evidence of residual fundus/neofundus, Hiatal hernia with good results in terms of weight loss. Group B (n = 9) patients with severe GERD, a residual fundus/neofundus, inadequate weight loss or weight regain. Fundectomy was indicated when a residual fundus/neofundus was associated with severe GERD symptoms. The presence of a residual fundus/neofundus was assessed by a barium swallow and/or multislice computed tomography.
  
  
  RESULTS
  No mortality or intra-operative complications occurred. Five postoperative complications occurred: 2 cases of bleeding, 1 mid-gastric stenosis and 2 leaks (10.5 %). All patients experienced improvements in their GERD symptoms and stopped PPI treatment. Group B exhibited an additional %EWL of 53.4 % at 24 months.
  
  
  CONCLUSIONS
  LF and cruroplasty is feasible and has good results in terms of GERD symptoms control and additional weight loss. The high rate of postoperative complications observed in this series remains a matter of concern. A re-sleeve procedure might be considered as an alternative to RYGB/DS conversion restricted to selected patients.
authors.affiliation: Division of General Surgery & Bariatric Center of Excellence, Department of Medico-Surgical Sciences and Biotechnology, Hospital ICOT, Sapienza University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy. gianfranco.silecchia@uniroma1.it.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Silecchia
authors.affiliation: Division of General Surgery & Bariatric Center of Excellence, Department of Medico-Surgical Sciences and Biotechnology, Hospital ICOT, Sapienza University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy. francescodeangelis4@alice.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: De Angelis
authors.affiliation: Division of General Surgery & Bariatric Center of Excellence, Department of Medico-Surgical Sciences and Biotechnology, Hospital ICOT, Sapienza University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzello
authors.affiliation: IFSO Bariatric Center of Excellence, Policlinico Universitario, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Albanese
authors.affiliation: Division of General Surgery & Bariatric Center of Excellence, Department of Medico-Surgical Sciences and Biotechnology, Hospital ICOT, Sapienza University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Longo
authors.affiliation: IFSO Bariatric Center of Excellence, Policlinico Universitario, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
authors.forename: Mirto
authors.initials: M
authors.lastname: Foletto
mesh_terms: D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods*; D005748:Gastric Fundus / Q000601:surgery*; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies
keywords: Fundectomy; GERD; Hiatal hernia; Obesity; Revised sleeve gastrectomy