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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.OS

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.

Authors+Show Affiliations

Department of Surgery, Division of Thoracic and Foregut Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15232, USA. raftopoulosi@upmc.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

15603654

Citation

Raftopoulos, Ioannis, et al. "Laparoscopic Gastric Bypass After Antireflux Surgery for the Treatment of Gastroesophageal Reflux in Morbidly Obese Patients: Initial Experience." Obesity Surgery, vol. 14, no. 10, 2004, pp. 1373-80.
Raftopoulos I, Awais O, Courcoulas AP, et al. Laparoscopic gastric bypass after antireflux surgery for the treatment of gastroesophageal reflux in morbidly obese patients: initial experience. Obes Surg. 2004;14(10):1373-80.
Raftopoulos, I., Awais, O., Courcoulas, A. P., & Luketich, J. D. (2004). Laparoscopic gastric bypass after antireflux surgery for the treatment of gastroesophageal reflux in morbidly obese patients: initial experience. Obesity Surgery, 14(10), 1373-80.
Raftopoulos I, et al. 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. PubMed PMID: 15603654.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic gastric bypass after antireflux surgery for the treatment of gastroesophageal reflux in morbidly obese patients: initial experience. AU - Raftopoulos,Ioannis, AU - Awais,Omar, AU - Courcoulas,Anita P, AU - Luketich,James D, PY - 2004/12/18/pubmed PY - 2005/3/23/medline PY - 2004/12/18/entrez SP - 1373 EP - 80 JF - Obesity surgery JO - Obes Surg VL - 14 IS - 10 N2 - 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. SN - 0960-8923 UR - https://www.unboundmedicine.com/medline/citation/15603654/Laparoscopic_gastric_bypass_after_antireflux_surgery_for_the_treatment_of_gastroesophageal_reflux_in_morbidly_obese_patients:_initial_experience_ L2 - https://dx.doi.org/10.1381/0960892042583950 DB - PRIME DP - Unbound Medicine ER -