Classification and indications for combined use of fundoplication in metabolic and bariatric surgery

Objective. Analysis of the results of using fundoplication in metabolic and bariatric surgery and classification of indications for its use. Material and methods. Within the framework of this study, a search for English-language articles was performed in the PubMed and Cochrane Library databases. The following search terms were used: «fundoplication», «bariatric», and then the words «gastric bypass», «sleeve gastrectomy», «combination», «plication» was added one by one. 503 publications were found in the databases, of which 49 sources were ultimately selected as corresponding to the objectives of the systematic review. The results of using a combination of fundoplication in bariatric and metabolic surgery were studied. Results. As a result of the analysis of scientific papers, the authors classified the indications for the combined use of fundoplication in metabolic and bariatric surgery. The types of combined use of laparoscopic sleeve gastrectomy with fundoplication are defined, and a classification of the combination of gastric bypass and fundoplication is described. The work indicates the place of Roux-en-Y gastric bypass and fundoplication in revision bariatric surgery. One anastomotic gastric bypass using the fundus of the excluded stomach and the results of using the FundoRing method are separately described. Conclusions. Thus, the analysis of the results of the combined use of fundoplication in metabolic and bariatric surgery indicates the following provisions.First, the possibility and necessity of classifying the combined use of fundoplication in various bariatric surgical methods. Secondly, the trend of using fundoplication not only for the treatment of preoperative GERD and prevention of postoperative reflux esophagitis, but also to improve the reliability of stapler sutures on the gastric pouch and to treat dumping syndrome, as well as to reduce the likelihood of weight regain of obesity after bariatric interventions.