Laparoscopic gastric bypass after antireflux surgery for the treatment of gastroesophageal reflux in morbidly obese patients: initial experience

Obes Surg. 2004 Nov-Dec;14(10):1373-80. doi: 10.1381/0960892042583950.

Abstract

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been proven effective against gastroesophageal reflux disease (GERD) in morbidly obese patients. We present our experience with revision of antireflux procedures to LRYGBP in obese patients with recurrent GERD, weight gain or a combination of both and discuss the indications and technical considerations involved.

Methods: Between June 2000 and December 2003, 7 morbidly obese patients with a mean BMI of 37.5 kg/m(2) underwent revision of an antireflux procedure to LRYGBP by our group. Important steps of the revision include dissection of the diaphragmatic crura and gastroesophageal fat pad, reduction and repair of hiatal hernia, and complete take-down of the wrap to avoid stapling over the fundoplication which can create an obstructed, septated pouch.

Results: Mean operative time was 6 hr 12 min and length of stay was 4.8 days. There were 3 major complications postoperatively and no deaths. During follow-up, 5 patients developed anastomotic strictures and 2 patients were re-explored for gastric remnant herniation and intestinal obstruction. At a mean follow-up of 24 (3-44) months, mean excess weight loss was 70.7% and 14/20 (70%) co-morbid conditions were improved or resolved. GERD evaluation with the GERD-HRQL scale showed a significant reduction of GERD scores postoperatively (P =0.006).

Conclusions: Although LRYGBP after antireflux surgery is a technically more difficult procedure with a higher morbidity, it is feasible and effective for the treatment of recurrent GERD and worsening obesity with the additional advantage of weight loss and improvement of co-morbidities.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Anastomosis, Roux-en-Y / adverse effects
  • Anastomosis, Roux-en-Y / methods
  • Body Mass Index
  • Female
  • Follow-Up Studies
  • Fundoplication / methods*
  • Gastric Bypass / adverse effects
  • Gastric Bypass / methods*
  • Gastroesophageal Reflux / complications
  • Gastroesophageal Reflux / diagnosis
  • Gastroesophageal Reflux / surgery*
  • Humans
  • Laparoscopy / adverse effects
  • Laparoscopy / methods*
  • Male
  • Middle Aged
  • Obesity, Morbid / complications
  • Obesity, Morbid / diagnosis
  • Obesity, Morbid / surgery*
  • Postoperative Complications
  • Retrospective Studies
  • Risk Assessment
  • Sampling Studies
  • Treatment Outcome
  • Weight Loss