title: Roux-en-Y gastric bypass for obesity after Belsey-Mark IV for large hiatus hernia and intrathoracic stomach, in combination with gastroesophageal reflux disease.
abstract: BACKGROUND
  Obesity is an increasing problem worldwide; patients who remain obese after non-surgical interventions are potential candidates for surgical intervention. Laparoscopic Roux-en-Y gastric bypass (RYGB) has proven its effects on excess weight loss and its positive effect on comorbidities and also, on reflux correction.
  
  
  METHODS
  Our patient, a 53-year-old male, with a BMI of 45 kg/m2and type 2 diabetes, underwent a Belsey-Mark IV procedure in another center because of a large hiatus hernia and intrathoracic stomach, in combination with gastroesophageal reflux disease (GERD). He consulted at our center concerning his morbid obesity. After a positive preoperative evaluation a RYGB was performed with an uneventful postoperative course.
  
  
  CONCLUSIONS
  RYGB is a safe and feasible procedure to perform after a Belsey-Mark IV procedure. To our knowledge, this is the first and only report of a RYGB after a Belsey-Mark IV procedure. There were no intra-operative complications and 18 months follow-up was unremarkable, with a 78.10% excess weight loss (EWL), at 86 kg, and no remaining symptoms of GERD. We also mention resolution of the patient's diabetes mellitus type 2 measured by the cessation of the glucophage, which is an added health benefit.
authors.affiliation: a Department of General and Abdominal Surgery , AZ St. Dimpna , Geel , Belgium.
authors.forename: Filip
authors.initials: F
authors.lastname: Haenen
authors.affiliation: a Department of General and Abdominal Surgery , AZ St. Dimpna , Geel , Belgium.
authors.forename: Ben
authors.initials: B
authors.lastname: Gys
authors.affiliation: a Department of General and Abdominal Surgery , AZ St. Dimpna , Geel , Belgium.
authors.forename: Tobie
authors.initials: T
authors.lastname: Gys
authors.affiliation: a Department of General and Abdominal Surgery , AZ St. Dimpna , Geel , Belgium.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lafullarde
keywords: Gastroesophageal reflux disease; Hiatal hernia; MeSH: laparoscopic Roux-en-Y gastric bypass