Background

This is the case of a 28 year old female who presented to clinic with acid reflux, nausea, vomiting, and food regurgitation. She had a who was laparoscopic converted to open Nissen Fundoplication ten years prior for severe reflux and heartburn. She had been following with gastroenterology, who referred her for a surgical consultation. She was on maximum medical therapy of a PPI twice daily, a H2 antagonist nightly, and calcium carbonate as needed. Her workup included esophageal manometry, 24 hour pH testing, and an endoscopy. Manometry showed normal esophageal motility with 4 cm hiatal hernia. The pH study was overall borderline positive for acid reflux. The endoscopy showed the hiatal hernia as well. The patient was deemed an operative candidate and underwent a takedown of her previous Nissen fundoplication with conversion to a roux-en-y bypass, performed with the robotic platform. The procedure went well without complication and the patient left on post-operative day 2 after she was able to tolerate some liquids by mouth. The patient was seen in clinic 10 days postoperatively. Her symptoms of reflux, regurgitation and nausea had greatly improved and she was tolerating a liquid diet well.