I present you here a very challenging case. History of Nissen fundoplication by laparoscopy perfomed 11 years ago with failure and valve reconstruction by laparotomy with a hiatal mesh. Reintervention by laparotomy 5 years ago for incisional hernia. GERD reccurence. I decided to perform a conversion in RYGB due to the failure of the valve but also the important BMI. The dissection can be a nightmare. The gastric pouch is a bit larger that I originally intended due to the poor vascularisation of the gastric pouch and the high risk of ischemia. Very good postoperative result.
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