Robotic Gastric Bypass as an Antireflux Procedure

Roux-en-Y gastric bypass (RYGB) is the second most common procedure performed for the surgical treatment of patients with morbid obesity. Robotic techniques are increasingly used to perform laparoscopic RYGB. In the case of persistent gastroesophageal reflux disease (GERD), especially after a prior fundoplication, in the setting of severe non-achalasia-related esophageal dysmotility or in the patient with morbid obesity, RYGB can provide resolution of GERD-related symptoms as the small gastric pouch can rapidly empty, and the gastroesophageal junction is tethered into the abdomen. This chapter outlines the diagnosis of GERD, the preoperative workup, operative steps including robotic setup and postoperative care of patients undergoing robotic RYGB as an antireflux procedure. In this chapter, we do not focus on the treatment of post-gastric band (fixed/adjustable) or post-sleeve gastrectomy reflux with conversion to RYGB.