Hybrid Technique (Toupet & OAGBP)

The patient is a 29-year-old woman with a body mass index (BMI) of 40.92. The patient has a history of gastroesophageal reflux with grade C oesophagitis and type I hiatal hernia. No other comorbidities were identified. The surgical approach was a single anastomosis gastric bypass with 180 centimeters of biliary bowel length and an associated 270-degree Toupet.Eleven months after the procedure, the BMI was 25.92 and the patient was completely free of reflux symptoms.Since September 1997, with the fortuitous creation of the single-anastomosis gastric bypass technique, and currently the third most performed procedure internationally, it has been observed that, following an increase in the number of publications in recent years, the percentage of biliary reflux suffered by these patients in some cases reaches 2 to 10%. As an alternative to this effect and to weight regain, one may consider performing a 360° Nissen-type fundoplication of the gastric remnant using the excluded stomach after releasing the short vessels. This approach has yielded favorable outcomes. However, the currently published technique requires fixation of the stomach to the remnant, an effect that is performed in the same way in the Toupet-type fundoplication with similar results in terms of reflux control, providing a decrease in the incidence of postoperative dysphagia compared to the Nissen technique. For this reason, we posit that the Toupet-type fundoplication effectively combines the two concepts, reducing the adverse effects of the 360-type fundoplication while maintaining the benefits of both techniques.