Tags

Type your tag names separated by a space and hit enter

Is Roux-en-Y gastric bypass safe after previous antireflux surgery? Technical feasibility and postoperative symptom assessment.
Surg Obes Relat Dis. 2005 Sep-Oct; 1(5):475-80.SO

Abstract

BACKGROUND

Clinically significant morbid obesity is associated with an increased risk of gastroesophageal reflux disease. Vertical Roux-en-Y gastric bypass (RYGBP) is known to eliminate acid (and bile) in the pouch of cardia, which would provide control of reflux symptoms. The aim of our study was to assess the technical considerations, morbidity, and safety of RYGBP after previous antireflux surgery and evaluate postoperative reflux symptoms.

METHODS

Retrospective review of all patients undergoing RYGBP after previous antireflux surgery from three institutions. Follow-up (mean 18 months) data were obtained from medical records and by questionnaire.

RESULTS

A total of 19 patients (18 women and 1 man) underwent standard (n = 18) or distal (n = 1) RYGBP 8 +/- 1 years after Nissen (n = 18) or Toupet (n = 1) fundoplication. Open RYGBP was undertaken in 17 of 19 patients. No postoperative deaths occurred. Substantive complications occurred in 4 patients (21%) and included hemorrhage requiring transfusion, concomitant splenectomy, and reoperation for suspected leak in 2. Of the 19 patients, 16 returned the questionnaire, 15 of whom reported subjective improvement in reflux symptoms after RYGBP compared with after antireflux surgery. No patient in this series required medical therapy for reflux symptoms at the last follow-up visit. The body mass index decreased from 42 +/- 2 kg/m(2) to 32 +/- 2 kg/m(2) (mean +/- SEM); all patients with >or=1 year of follow-up had a body mass index of <or=32 kg/m(2). At last follow-up, 88% of patients were very satisfied subjectively with their outcome.

CONCLUSIONS

RYGBP after previous antireflux surgery is technically feasible and safe, but it is associated with greater complication rates than those seen with other forms of reoperative bariatric procedures. RYGBP results in effective weight loss, controls reflux symptoms, and may be the procedure of choice in morbidly obese patients with previous antireflux surgery, and obese patients requiring surgical treatment for gastroesophageal reflux disease.

Authors+Show Affiliations

Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

16925273

Citation

Houghton, Scott G., et al. "Is Roux-en-Y Gastric Bypass Safe After Previous Antireflux Surgery? Technical Feasibility and Postoperative Symptom Assessment." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 1, no. 5, 2005, pp. 475-80.
Houghton SG, Nelson LG, Swain JM, et al. Is Roux-en-Y gastric bypass safe after previous antireflux surgery? Technical feasibility and postoperative symptom assessment. Surg Obes Relat Dis. 2005;1(5):475-80.
Houghton, S. G., Nelson, L. G., Swain, J. M., Nesset, E. M., Kendrick, M. L., Thompson, G. B., Murr, M. M., Nichols, F. C., & Sarr, M. G. (2005). Is Roux-en-Y gastric bypass safe after previous antireflux surgery? Technical feasibility and postoperative symptom assessment. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 1(5), 475-80.
Houghton SG, et al. Is Roux-en-Y Gastric Bypass Safe After Previous Antireflux Surgery? Technical Feasibility and Postoperative Symptom Assessment. Surg Obes Relat Dis. 2005 Sep-Oct;1(5):475-80. PubMed PMID: 16925273.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is Roux-en-Y gastric bypass safe after previous antireflux surgery? Technical feasibility and postoperative symptom assessment. AU - Houghton,Scott G, AU - Nelson,Lana G, AU - Swain,James M, AU - Nesset,Elizabeth M, AU - Kendrick,Michael L, AU - Thompson,Geoffrey B, AU - Murr,Michel M, AU - Nichols,Francis C, AU - Sarr,Michael G, Y1 - 2005/08/31/ PY - 2005/05/06/received PY - 2005/06/27/revised PY - 2005/07/07/accepted PY - 2006/8/24/pubmed PY - 2006/10/13/medline PY - 2006/8/24/entrez SP - 475 EP - 80 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 1 IS - 5 N2 - BACKGROUND: Clinically significant morbid obesity is associated with an increased risk of gastroesophageal reflux disease. Vertical Roux-en-Y gastric bypass (RYGBP) is known to eliminate acid (and bile) in the pouch of cardia, which would provide control of reflux symptoms. The aim of our study was to assess the technical considerations, morbidity, and safety of RYGBP after previous antireflux surgery and evaluate postoperative reflux symptoms. METHODS: Retrospective review of all patients undergoing RYGBP after previous antireflux surgery from three institutions. Follow-up (mean 18 months) data were obtained from medical records and by questionnaire. RESULTS: A total of 19 patients (18 women and 1 man) underwent standard (n = 18) or distal (n = 1) RYGBP 8 +/- 1 years after Nissen (n = 18) or Toupet (n = 1) fundoplication. Open RYGBP was undertaken in 17 of 19 patients. No postoperative deaths occurred. Substantive complications occurred in 4 patients (21%) and included hemorrhage requiring transfusion, concomitant splenectomy, and reoperation for suspected leak in 2. Of the 19 patients, 16 returned the questionnaire, 15 of whom reported subjective improvement in reflux symptoms after RYGBP compared with after antireflux surgery. No patient in this series required medical therapy for reflux symptoms at the last follow-up visit. The body mass index decreased from 42 +/- 2 kg/m(2) to 32 +/- 2 kg/m(2) (mean +/- SEM); all patients with >or=1 year of follow-up had a body mass index of <or=32 kg/m(2). At last follow-up, 88% of patients were very satisfied subjectively with their outcome. CONCLUSIONS: RYGBP after previous antireflux surgery is technically feasible and safe, but it is associated with greater complication rates than those seen with other forms of reoperative bariatric procedures. RYGBP results in effective weight loss, controls reflux symptoms, and may be the procedure of choice in morbidly obese patients with previous antireflux surgery, and obese patients requiring surgical treatment for gastroesophageal reflux disease. SN - 1550-7289 UR - https://www.unboundmedicine.com/medline/citation/16925273/Is_Roux_en_Y_gastric_bypass_safe_after_previous_antireflux_surgery_Technical_feasibility_and_postoperative_symptom_assessment_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(05)00602-7 DB - PRIME DP - Unbound Medicine ER -