Abstract
One of the successful strategies for avoiding reflux esophagitis and other issues following gastric bypass is the FundoRing method of gastric bypass with fundoplication employing the excluded (remnant) portion of the stomach. This study aims to describe the standardization of the different specific steps of surgical techniques of FundoRing for performing one anastomosis gastric bypass (OAGB) and describes the two-year outcomes of the standardized procedure compared to non-standardized surgery. This work describes the update of the details of standardization of the surgical technique of the FundoRing method for laparoscopic gastric bypass based on previously non-standardized experiments. The study design was a clinical, comparative, two-year follow-up study involving two groups using a one-anastomotic gastric bypass (OAGB). FundoRingOAGB was performed in the first (standardization) group, and in the second group (a non-standardized group), the NissenOAGB was used. The specific steps of the FundoRing surgical procedure are: mandatory division of the gastrosplenic ligament for the creation of a circular fundoplication 5 cm in length, and supplemented by a partial fundoplication of another 2 cm. The total size of the fundoplication wrap is 7 cm. A suture of fundoplication wrap is created with autologous tissues at 3 and 6 o’clock on the “dial” of the gastric pouch between the left (anterior) and right (posterior) parts of the wrap, thus performing double calibration, and the FundoRing is ready. At 24 months post-treatment, BMI changes were as follows: from 40.7 ± 5.9 (31–53) kg/m(2) to 24.3 ± 2.8 (19–29) kg/m(2) in “after standardisation” (first) group, versus 40.9 ± 6.3 (33–53) kg/m(2) to 28.1 ± 3.9 (24–34) kg/m(2) in “before standardisation” (second) group. Over 2 years, no cases of serious complications were observed in the FundoRingOAGB group (standardization group) compared to the NissenOAGB (non-standardization group), which had 11 (22%) complications (p = 001). The surgical technique of FundoRing has specific, distinctive steps. It involves a wider mobilization of the fundus and the need to perform double calibration of the wrap when creating a circular or partial fundoplication, oriented toward the stapler suture of the gastric pouch to create a living ring (band) from autologous tissue. The standardization of the surgical technique of the FundoRing method for laparoscopic gastric bypass improves weight loss outcomes and complication prevention. Research registration unique identifying number: NCT04828733 in the ClinicalTrials.gov. Date of first registration: March 29, 2019.