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Nassif PAN, Malafaia O, Ribas-Filho JM, Czeczko NG, Garcia RF, Ariede BL. Vertical gastrectomy and gastric bypass in Roux-en-Y induce postoperative gastroesophageal reflux disease? ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 27 Suppl 1:63-8. [PMID: 25409970 PMCID: PMC4743523 DOI: 10.1590/s0102-6720201400s100016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 11/08/2014] [Indexed: 12/15/2022]
Abstract
Background The association between obesity and gastroesophageal reflux disease has a high
incidence and may be present in half of obese patients with surgical indication.
Bariatric operations can also induce reflux alone - differently from BMI factors -
and its mechanisms are dependent on the type of procedure performed. Objective To perform a literature review comparing the two procedures currently most used
for surgical treatment of obesity and analyze their relationship with the advent
of pre-existing reflux disease or its appearance only in postoperative period. Method The literature was reviewed in virtual database Medline/PubMed, SciELO, Lilacs,
Embase and Cochrane crossing the following MeSH descriptors: gastric bypass AND /
OR anastomosis, Roux-en-Y AND / OR gastroesophageal reflux AND / OR
gastroenterostomy AND / OR gastrectomy AND / OR obesity AND / OR bariatric surgery
AND / OR postoperative period. A total of 135 relevant references were considered
but only 30 were used in this article. Also was added the experience of the
authors of this article in handling these techniques on this field. Conclusion The structural changes caused by surgical technique in vertical gastrectomy shows
greater commitment of antireflux mechanisms predisposing the induction of GERD
postoperatively compared to the surgical technique performed in the
gastrointestinal Bypass Roux-en-Y.
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Affiliation(s)
- Paulo Afonso Nunes Nassif
- Medical Research Institute, University Evangelic Hospital of Curitiba, Evangelic Faculty of Paraná, Curitiba, PR, Brazil
| | - Osvaldo Malafaia
- Medical Research Institute, University Evangelic Hospital of Curitiba, Evangelic Faculty of Paraná, Curitiba, PR, Brazil
| | - Jurandir Marcondes Ribas-Filho
- Medical Research Institute, University Evangelic Hospital of Curitiba, Evangelic Faculty of Paraná, Curitiba, PR, Brazil
| | - Nicolau Gregori Czeczko
- Medical Research Institute, University Evangelic Hospital of Curitiba, Evangelic Faculty of Paraná, Curitiba, PR, Brazil
| | - Rodrigo Ferreira Garcia
- Medical Research Institute, University Evangelic Hospital of Curitiba, Evangelic Faculty of Paraná, Curitiba, PR, Brazil
| | - Bruno Luiz Ariede
- Medical Research Institute, University Evangelic Hospital of Curitiba, Evangelic Faculty of Paraná, Curitiba, PR, Brazil
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Luketina RR, Koch OO, Köhler G, Antoniou SA, Emmanuel K, Pointner R. Obesity does not affect the outcome of laparoscopic antireflux surgery. Surg Endosc 2014; 29:1327-33. [PMID: 25294529 DOI: 10.1007/s00464-014-3842-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/19/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Obesity has been reported to adversely affect the outcome of laparoscopic antireflux surgery (LARS). This study examined pre- and postoperative clinical and objective outcomes and quality of life in obese and normal-weight patients following LARS at a specialized centre. METHODS Prospective data from patients subjected to LARS (Nissen or Toupet fundoplication) for symptomatic gastroesophageal reflux disease in the General Public Hospital of Zell am See were analyzed. Patients were divided in two groups: normal weight [body mass index (BMI) 20-25 kg/m(2)] and obese (BMI ≥ 30 kg/m(2)). Gastrointestinal quality of life index (GIQLI), symptom grading, esophageal manometry and multichannel intraluminal impedance monitoring data were documented and compared preoperatively and at 1 year postoperatively. RESULT The study cohort included forty normal-weight and forty obese patients. Mean follow-up was 14.7 ± 2.4 months. The mean GIQLI improved significantly after surgery in both groups (p < 0.001, for both). Clinical outcomes improved following surgery regardless of BMI. There were significant improvements of typical and atypical reflux symptoms in normal weight and obese (p = 0.007; p = 0.006, respectively), but no difference in gas bloat and bowel dysfunction symptoms could be found. No intra- or perioperative complications occurred. A total of six patients had to be reoperated (7.5 %), two (5 %) in the obese group and four (10 %) in the normal-weight group, because of recurrent hiatal hernia and slipping of the wrap or persistent dysphagia due to closure of the wrap. CONCLUSION Obesity is not associated with a poorer clinical and objective outcome after LARS. Increased BMI seems not to be a risk factor for recurrent symptomatology and reoperation.
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Varban OA, Hawasli AA, Carlin AM, Genaw JA, English W, Dimick JB, Wood MH, Birkmeyer JD, Birkmeyer NJO, Finks JF. Variation in utilization of acid-reducing medication at 1 year following bariatric surgery: results from the Michigan Bariatric Surgery Collaborative. Surg Obes Relat Dis 2014; 11:222-8. [PMID: 24981934 DOI: 10.1016/j.soard.2014.04.027] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/01/2014] [Accepted: 04/09/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Morbidly obese patients undergoing bariatric surgery have high rates of gastroesophageal reflux and are often treated with acid-reducing medications (ARM) such as proton pump inhibitors or H2-blockers. The objective of this study was to evaluate the effect of bariatric procedures on the utilization of ARM. We analyzed data from the clinical registry of the Michigan Bariatric Surgery Collaborative on 35,477 patients undergoing bariatric surgery between January 2006 and October 2012 who completed both baseline and 1-year follow-up surveys. Procedures included laparoscopic adjustable gastric banding (LAGB, n=2,627), Roux-en-Y gastric bypass (RYGB, n=6,410), sleeve gastrectomy (SG, n=1,567), and biliopancreatic diversion with duodenal switch (BPD/DS, n=162). METHODS Rates of ARM at 1 year by procedure type were compared using logistic regression analysis. Models were adjusted for patient characteristics, baseline co-morbidities, weight loss, and hiatal hernia repair. RESULTS Overall ARM use at baseline was 37.7% and declined to 29.6% at 1 year after bariatric surgery. The proportion of patients starting an ARM at 1 year when they were not using one at baseline by procedure was LAGB (13.9%), RYGB (19.2%), SG (21.6%), and BPD/DS (26.7%). The proportion of patients discontinuing an ARM at 1 year when they were using one at baseline by procedure was LAGB (55.6%), RYGB (56.2%), SG (37.3%), and BPD/DS (42.1%). Compared with LAGB on multivariable analysis, the likelihood of ARM use at 1 year was higher for SG (OR 1.70, 95% CI 1.45-1.99) and BDP/DS (OR 1.53, CI .97-2.40) but not different for RYGB (OR 1.02, CI .90-1.16). CONCLUSION Overall ARM use decreases after bariatric surgery; however, it is not uniform and depends on procedure type. SG is a significant predictor for ARM use at 1 year.
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Affiliation(s)
- Oliver A Varban
- Value Partnerships Program, Blue Cross and Blue Shield of Michigan, and the Center for Healthcare Outcomes and Policy and Department of Surgery, University of Michigan, Ann Arbor, Michigan.
| | - Abdelkader A Hawasli
- Department of Surgery, St. John Providence Health System, St. Clair Shores, Michigan
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Jeffrey A Genaw
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Wayne English
- Department of Surgery, Marquette General Hospital, Marquette, Michigan
| | - Justin B Dimick
- Value Partnerships Program, Blue Cross and Blue Shield of Michigan, and the Center for Healthcare Outcomes and Policy and Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michael H Wood
- Department of Surgery, Detroit Medical Center, Detroit, Michigan
| | - John D Birkmeyer
- Value Partnerships Program, Blue Cross and Blue Shield of Michigan, and the Center for Healthcare Outcomes and Policy and Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Nancy J O Birkmeyer
- Value Partnerships Program, Blue Cross and Blue Shield of Michigan, and the Center for Healthcare Outcomes and Policy and Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jonathan F Finks
- Value Partnerships Program, Blue Cross and Blue Shield of Michigan, and the Center for Healthcare Outcomes and Policy and Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Telem DA, Altieri M, Gracia G, Pryor AD. Perioperative outcome of esophageal fundoplication for gastroesophageal reflux disease in obese and morbidly obese patients. Am J Surg 2014; 208:163-8. [PMID: 24881017 DOI: 10.1016/j.amjsurg.2014.02.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 12/25/2013] [Accepted: 02/27/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND To determine the perioperative safety of esophageal fundoplication for gastroesophageal reflux disease (GERD) in patients with body mass index (BMI) ≥ 35 kg/m(2). METHODS A retrospective review of 4,231 patients who underwent fundoplication for GERD from 2005 to 2009 was performed. Patients were identified via National Surgical Quality Improvement Program and grouped by BMI < 35 versus BMI ≥ 35 kg/m(2). Univariate analysis compared 30-day outcomes. RESULTS Of the 4,231 patients, 3,496 (83%) had BMI < 35 kg/m(2) and 735 (17%) had BMI ≥ 35 kg/m(2). Mean BMI for each cohort was 27.9 versus 39.1, respectively. Patients with BMI ≥ 35 kg/m(2) had significantly longer operative times (129.7 vs 118 minutes, P < .0001) and increased American Society of Anesthesiologists scores (2.43 vs 2.3, P = .001). The overall complication rate was 1.96%. No difference was demonstrated by BMI in complication rate or hospital length of stay. Increased American Society of Anesthesiologists score, diabetes, black race, longer operative time, and intraoperative transfusion significantly increased postoperative complication rates. CONCLUSIONS No increased risk is conferred to morbidly obese patients who undergo fundoplication for GERD management. This study identified independent patient risk factors for postoperative complication following esophageal fundoplication.
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Affiliation(s)
- Dana A Telem
- Division of Laparoscopic, Bariatric and Advanced GI Surgery, Stony Brook University Medical Center, 100 Nichols Road, Stony Brook, NY 11794, USA.
| | - Maria Altieri
- Division of Laparoscopic, Bariatric and Advanced GI Surgery, Stony Brook University Medical Center, 100 Nichols Road, Stony Brook, NY 11794, USA
| | - Gerald Gracia
- Division of Laparoscopic, Bariatric and Advanced GI Surgery, Stony Brook University Medical Center, 100 Nichols Road, Stony Brook, NY 11794, USA
| | - Aurora D Pryor
- Division of Laparoscopic, Bariatric and Advanced GI Surgery, Stony Brook University Medical Center, 100 Nichols Road, Stony Brook, NY 11794, USA
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Mahawar KK, Jennings N, Balupuri S, Small PK. Sleeve gastrectomy and gastro-oesophageal reflux disease: a complex relationship. Obes Surg 2014; 23:987-91. [PMID: 23460263 DOI: 10.1007/s11695-013-0899-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Sleeve gastrectomy is rapidly becoming popular as a standalone bariatric operation. At the same time, there are valid concerns regarding its long-term durability and postoperative gastro-oesophageal reflux disease. Though gastric bypass remains the gold standard bariatric operation, it is not suitable for all patients. Sleeve gastrectomy is sometimes the only viable option. Patients with inflammatory bowel disease, liver cirrhosis, significant intra-abdominal adhesions involving small bowel and those reluctant to undergo gastric bypass could fall in this category. It is widely recognised that some patients report worsening of their gastro-oesophageal reflux disease after sleeve gastrectomy. Still, others develop de novo reflux. This review examines if it is possible to identify these patients prior to surgery and thus prevent postoperative gastro-oesophageal reflux disease after sleeve gastrectomy.
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Affiliation(s)
- Kamal K Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK.
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Laurenius A, Olbers T, Näslund I, Karlsson J. Dumping syndrome following gastric bypass: validation of the dumping symptom rating scale. Obes Surg 2014; 23:740-55. [PMID: 23315151 DOI: 10.1007/s11695-012-0856-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
There is a lack of prevalent data for dumping syndrome (DS) and methods discriminating between different symptoms of the DS. A self-assessment questionnaire, the Dumping Symptom Rating Scale (DSRS), was developed. The aim was to measure the severity and frequency of nine dumping symptoms and to evaluate the construct validity of the DSRS. Pre- and 1 and 2 years after Roux-en-Y gastric bypass surgery, 47 adults and 82 adolescents completed the DSRS. Cognitive interview was performed. Reliability and construct validity were tested. Effect sizes (ES) of changes were calculated. Patients found the questionnaire relevant. A high proportion of the respondents reported no symptoms affecting them negatively at all (floor effects). However, 12 % stated, quite severe, severe, or very severe problems regarding fatigue after meal and half of them were so tired that they needed to lie down. Nearly 7 % reported quite severe, severe, or very severe problems dominated by nausea and 6 % dominated by fainting esteem. The internal consistency reliability was adequate for both severity (0.81-0.86) and frequency (0.76-0.84) scales. ES were small, since some subjects experienced symptoms already preoperatively. Although most patients reported no or mild dumping symptoms 1 and 2 years after gastric bypass surgery, around 12 % had persistent symptoms, in particular, postprandial fatigue, and needed to lie down. Another 7 % had problems with nausea and 6 % had problems with fainting esteem. The DSRS is a reliable screening tool to identify these patients.
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Affiliation(s)
- Anna Laurenius
- Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Pagé MP, Kastenmeier A, Goldblatt M, Frelich M, Bosler M, Wallace J, Gould J. Medically refractory gastroesophageal reflux disease in the obese: what is the best surgical approach? Surg Endosc 2013; 28:1500-4. [DOI: 10.1007/s00464-013-3343-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 11/13/2013] [Indexed: 12/22/2022]
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Huerta-Iga F, Tamayo-de la Cuesta JL, Noble-Lugo A, Hernández-Guerrero A, Torres-Villalobos G, Ramos-de la Medina A, Pantoja-Millán JP. [The Mexican consensus on gastroesophageal reflux disease. Part II]. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2013; 78:231-9. [PMID: 24290724 DOI: 10.1016/j.rgmx.2013.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 05/14/2013] [Accepted: 05/27/2013] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To update the themes of endoscopic and surgical treatment of Gastroesophageal Reflux Disease (GERD) from the Mexican Consensus published in 2002. METHODS Part I of the 2011 Consensus dealt with the general concepts, diagnosis, and medical treatment of this disease. Part II covers the topics of the endoscopic and surgical treatment of GERD. In this second part, an expert in endoscopy and an expert in GERD surgery, along with the three general coordinators of the consensus, carried out an extensive bibliographic review using the Embase, Cochrane, and Medline databases. Statements referring to the main aspects of endoscopic and surgical treatment of this disease were elaborated and submitted to specialists for their consideration and vote, utilizing the modified Delphi method. The statements were accepted into the consensus if the level of agreement was 67% or higher. RESULTS Twenty-five statements corresponding to the endoscopic and surgical treatment of GERD resulted from the voting process, and they are presented herein as Part II of the consensus. The majority of the statements had an average level of agreement approaching 90%. CONCLUSION Currently, endoscopic treatment of GERD should not be regarded as an option, given that the clinical results at 3 and 5 years have not demonstrated durability or sustained symptom remission. The surgical indications for GERD are well established; only those patients meeting the full criteria should be candidates and their surgery should be performed by experts.
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Affiliation(s)
- F Huerta-Iga
- Encargado del Servicio de Endoscopia, Hospital Ángeles Torreón, Coahuila, México.
| | | | - A Noble-Lugo
- Departamento de Enseñanza, Hospital Español de México, México D.F., México
| | - A Hernández-Guerrero
- Jefe del Servicio de Endoscopia, Instituto Nacional de Cancerología, México D.F., México
| | - G Torres-Villalobos
- Servicio de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México D.F., México
| | | | - J P Pantoja-Millán
- Cirugía del Aparato Digestivo, Hospital Ángeles del Pedregal, México D.F., México
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Bonavina L, Siboni S, Saino GI, Cavadas D, Braghetto I, Csendes A, Korn O, Figueredo EJ, Swanstrom LL, Wassenaar E. Outcomes of esophageal surgery, especially of the lower esophageal sphincter. Ann N Y Acad Sci 2013; 1300:29-42. [PMID: 24117632 DOI: 10.1111/nyas.12232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This paper includes commentaries on outcomes of esophageal surgery, including the mechanisms by which fundoduplication improves lower esophageal sphincter (LES) pressure; the efficacy of the Linx™ management system in improving LES function; the utility of radiologic characterization of antireflux valves following surgery; the correlation between endoscopic findings and reported symptoms following antireflux surgery; the links between laparoscopic sleeve gastrectomy and decreased LES pressure, endoscopic esophagitis, and gastroesophageal reflux disease (GERD); the less favorable outcomes following fundoduplication among obese patients; the application of bioprosthetic meshes to reinforce hiatal repair and decrease the incidence of paraesophageal hernia; the efficacy of endoluminal antireflux procedures, and the limited efficacy of revisional antireflux operations, underscoring the importance of good primary surgery and diligent work-up to prevent the necessity of revisional procedures.
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Affiliation(s)
- Luigi Bonavina
- General Surgery, IRCCS, University of Milano, Milano, Italy
| | - Stefano Siboni
- General Surgery, IRCCS, University of Milano, Milano, Italy
| | - Greta I Saino
- General Surgery, IRCCS, University of Milano, Milano, Italy
| | - Demetrio Cavadas
- Department of Surgery, Hospital Italiano, Buenos Aires, Argentina
| | - Italo Braghetto
- Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Attila Csendes
- Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Owen Korn
- Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Edgar J Figueredo
- Department of Surgery, University of Washington, Seattle, Washington
| | | | - Eelco Wassenaar
- Department of Surgery, University of Washington, Seattle, Washington
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Huerta-Iga F, Tamayo-de la Cuesta J, Noble-Lugo A, Hernández-Guerrero A, Torres-Villalobos G, Ramos-de la Medina A, Pantoja-Millán J. The Mexican consensus on gastroesophageal reflux disease. Part II. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2013. [DOI: 10.1016/j.rgmxen.2014.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Laparoscopic treatment of obese patients with gastroesophageal reflux disease and Barrett's esophagus: a prospective study. Obes Surg 2012; 22:764-72. [PMID: 22392129 DOI: 10.1007/s11695-011-0531-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Short-segment Barrett's esophagus (SSBE) or long-segment Barrett's esophagus (LSBE) is the consequence of chronic gastroesophageal reflux disease (GERD), which is frequently associated with obesity. Obesity is a significant risk factor for the development of GERD symptoms, erosive esophagitis, Barrett's esophagus, and esophageal adenocarcinoma. Morbidly obese patients who submitted to gastric bypass have an incidence of GERD as high as 50% to 100% and Barrett's esophagus reaches up to 9% of patients. METHODS In this prospective study, we evaluate the postoperative results after three different procedures--calibrated fundoplication + posterior gastropexy (CFPG), fundoplication + vagotomy + distal gastrectomy + Roux-en-Y gastrojejunostomy (FVDGRYGJ), and laparoscopic resectional Roux-en-Y gastric bypass (LRRYGBP)--among obese patients. RESULTS In patients with SSBE who submitted to CFPG, the persistence of reflux symptoms and endoscopic erosive esophagitis was observed in 15% and 20.2% of them, respectively. Patients with LSBE were submitted to FVDGRYGJ or LRRYGBP which significantly improved their symptoms and erosive esophagitis. No modifications of LESP were observed in patients who submitted to LRRYGBP before or after the operation. Acid reflux diminished after the three types of surgery were employed. Patients who submitted to LRRYGBP presented a significant reduction of BMI from 41.5 ± 4.3 to 25.7 ± 1.3 kg/m(2) after 12 months. CONCLUSIONS Among patients with LSBE, FVDGRYGJ presents very good results in terms of improving GERD and Barrett's esophagus, but the reduction of weight is limited. LRRYGBP improves GERD disease and Barrett's esophagus with proven reduction in body weight and BMI, thus becoming the procedure of choice for obese patients.
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Laparoscopic fundoplication takedown with conversion to Roux-en-Y gastric bypass leads to excellent reflux control and quality of life after fundoplication failure. Surg Endosc 2012; 26:3521-7. [DOI: 10.1007/s00464-012-2380-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 05/15/2012] [Indexed: 11/26/2022]
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Abstract
Obesity and gastroesophageal reflux disease (GERD) are common chronic illnesses. They often coexist and need to be treated concomitantly. Fundoplication may be effective for the short-term control of GERD in the obese patient; however, this procedure does not induce weight loss or treat the comorbid conditions related to obesity. Roux-en-Y gastric bypass is a highly effective treatment of GERD, obesity, and the associated comorbidities. Surgeons who are not comfortable with a bariatric surgical procedure in these patients should either complete appropriate advanced training in bariatric surgery or refer those patients to a qualified surgeon who can offer these options.
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Affiliation(s)
- Kevin M Reavis
- Division of Gastrointestinal Surgery, Department of Surgery, University of California, Irvine Medical Center, 333 City Boulevard West, Suite 850, Orange, CA 92868, USA.
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64
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The impact of previous fundoplication on laparoscopic gastric bypass outcomes: a case-control evaluation. Surg Endosc 2011; 26:177-81. [PMID: 21858578 DOI: 10.1007/s00464-011-1851-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 07/04/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is a common comorbid condition in morbidly obese gastric bypass candidates. Unfortunately, some patients who ultimately present for bariatric surgery have previously undergone Nissen fundoplication for GERD. Many surgeons consider previous fundoplication to be a relative contraindication to subsequent laparoscopic Roux-en-Y gastric bypass (LRYGB) due to increased technical complexity and risk. We sought to compare the perioperative and long-term outcomes of a cohort of patients who had first undergone fundoplication and ultimately chose to later pursue LRYGB for morbid obesity (revision) to matched control patients. METHODS Data were obtained from our prospectively maintained bariatric surgery database. Patients who underwent laparoscopic takedown of a previous fundoplication and conversion to LRYGB were compared to control patients who underwent primary LRYGB. For every revision patient, two control subjects were randomly selected from the database after matching for preoperative body mass index and year of surgery. RESULTS From July 2002 to April 2011, 14 patients underwent laparoscopic takedown of a previous Nissen fundoplication and then underwent LRYGB. During the same interval, 673 patients underwent LRYGB as a primary procedure for obesity from which 28 were selected as controls. There were no conversions to open laparotomy in any patient. Subjects were similar demographically. Operating time and duration of hospital stay were significantly longer in revision patients. Complications were more frequent in revisions (36% revisions vs. 7% controls, P = 0.03). Excess weight loss 1-year after surgery was excellent in both groups and did not differ (69% revision vs. 69.6% controls, P = 0.93). CONCLUSIONS Although associated with longer operating times, longer duration of hospital stay, and complications, LRYGB after fundoplication is feasible and safe. Long-term weight loss outcomes are similar to those seen following primary LRYGB. Previous fundoplication is not a contraindication to LRYGB.
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Wang YR, Dempsey DT, Richter JE. Trends and perioperative outcomes of inpatient antireflux surgery in the United States, 1993-2006. Dis Esophagus 2011; 24:215-23. [PMID: 21073616 DOI: 10.1111/j.1442-2050.2010.01123.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Antireflux surgery is an effective treatment for gastroesophageal reflux disease, but postoperation complications and durability may be problematic. The objective of the study was to determine whether inpatient antireflux surgery continued to decline in the United States due to concerns about its long-term effectiveness and the popularity of gastric bypass surgery and to assess recent changes in its perioperative outcomes. Using the Nationwide Inpatient Sample, we identified adult patients undergoing inpatient antireflux surgery during 1993-2006 and compared the trends of inpatient antireflux surgery with inpatient gastric bypass surgery. Perioperative complications included laceration, splenectomy, transfusion, esophageal dilation, total parenteral nutrition, and infection. Inpatient antireflux surgery increased from 9173 in 1993 to 32 980 in 2000 (+260%) but then decreased to 19 668 in 2006 (-40%). Compared with 2000, patients undergoing inpatient antireflux surgery in 2006 were older (49.9 ± 32.4 vs. 54.6 ± 33.6 years) and had a longer length of stay (3.1 ± 10.0 vs. 3.7 ± 13.4 days), more complications (4.7% vs. 6.1%), and higher mortality (0.26% vs. 0.54%) (all P < 0.05). Compared with inpatient gastric bypass surgery, length of stay was longer and mortality was higher for inpatient antireflux surgery in 2006, but neither was significant controlling for age. In 2006, perioperative outcomes of inpatient antireflux surgery were better in high-volume hospitals (all P < 0.01). Inpatient antireflux surgery continued to decline in the United States from 2000 to 2006, concomitant with a dramatic increase in inpatient gastric bypass surgery. Older patient age and worsening perioperative outcomes for inpatient antireflux surgery suggest increased medical complexity and possibly a larger share of reoperations over time. Designating centers of excellence for antireflux surgery based on local expertise may improve outcomes.
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Affiliation(s)
- Y R Wang
- Department of Medicine, Temple University School of Medicine, University of Pennsylvania, Philadelphia, PA 19140, USA
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Lidor AO, Chang DC, Feinberg RL, Steele KE, Schweitzer MA, Franco MM. Morbidity and mortality associated with antireflux surgery with or without paraesophogeal hernia: a large ACS NSQIP analysis. Surg Endosc 2011; 25:3101-8. [DOI: 10.1007/s00464-011-1676-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 03/11/2011] [Indexed: 01/09/2023]
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Stefanidis D, Hope WW, Kohn GP, Reardon PR, Richardson WS, Fanelli RD. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc 2010; 24:2647-69. [PMID: 20725747 DOI: 10.1007/s00464-010-1267-8] [Citation(s) in RCA: 238] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 05/27/2010] [Indexed: 02/06/2023]
Affiliation(s)
- Dimitrios Stefanidis
- Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC, USA.
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Prachand VN, Alverdy JC. Gastroesophageal reflux disease and severe obesity: Fundoplication or bariatric surgery? World J Gastroenterol 2010; 16:3757-61. [PMID: 20698037 PMCID: PMC2921086 DOI: 10.3748/wjg.v16.i30.3757] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Increases in the prevalence of obesity and gastroesophageal reflux disease (GERD) have paralleled one another over the past decade, which suggests the possibility of a linkage between these two processes. In both instances, surgical therapy is recognized as the most effective treatment for severe, refractory disease. Current surgical therapies for severe obesity include (in descending frequency) Roux-en-Y gastric bypass, adjustable gastric banding, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch, while fundoplication remains the mainstay for the treatment of severe GERD. In several large series, however, the outcomes and durability of fundoplication in the setting of severe obesity are not as good as those in patients who are not severely obese. As such, bariatric surgery has been suggested as a potential alternative treatment for these patients. This article reviews current concepts in the putative pathophysiological mechanisms by which obesity contributes to gastroesophageal reflux and their implications with regards to surgical therapy for GERD in the setting of severe obesity.
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Braghetto I, Lanzarini E, Korn O, Valladares H, Molina JC, Henriquez A. Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients. Obes Surg 2009; 20:357-62. [PMID: 20013071 DOI: 10.1007/s11695-009-0040-3] [Citation(s) in RCA: 173] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 11/17/2009] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy has been accepted as an option for surgical treatment of obesity. After surgery, some patients present reflux symptoms associated with endoscopic esophagitis, therefore PPI's treatment must be indicated. PURPOSE This study aims to evaluate the manometric characteristic of the lower esophageal sphincter (LES) before and after sleeve gastrectomy MATERIAL AND METHOD This prospective study includes 20 patients submitted to esophageal manometry in order to determine the resting pressure, and total and abdominal LES length before and after the sleeve gastrectomy. Statistical variations on the LESP were validated according to Student's "t" test. RESULTS Seventeen female and three male patients were included, with a mean age of 37.6 +/- 12.6 years. All patients reduced their body weight, from an initial BMI of 38.3 kg/m(2) to 28.2 kg/m(2) 6 months after surgery. No postoperative complications were observed in these patients. Preoperative mean LESP was 14.2 +/- 5.8 mmHg. Postoperative manometry decreased in 17/20 (85%), with a mean value of 11.2 +/- 5.7 mmHg (p = 0.01). Seven of them presented LESP <12 mmHg and ten patients <6 mmHg after the operation. Furthermore, the abdominal length and total length of the high pressure zone at the esophagogastric junction were affected. CONCLUSION A sleeve gastrectomy produces an important decrease in LES pressure, which can in turn cause the appearance of reflux symptoms and esophagitis after the operation due to a partial resection of the sling fibers during the gastrectomy.
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Affiliation(s)
- Italo Braghetto
- Department of Surgery, Faculty of Medicine, University of Chile, Santos Dumont 999, Santiago, Chile.
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