Laparoscopic Roux-en-Y Bypass For Gastroesophageal Reflux Disease
About Recalcitrant GERD
| Bariatric Surgery information Laparoscopic Roux-en-Y Bypass For Gastroesophageal Reflux Disease |
About Recalcitrant GERD |
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Laparoscopic Roux-en-Y Gastric Bypass For Recalcitrant Gastroesophageal
Reflux Disease in Gastroesophageal reflux disease (GERD) is commonly associated with morbid obesity (MO). Antireflux surgery has a higher failure rate in MO and addresses only one of the comorbidities present. This paper reviews the results of laparoscopic Roux-en-Y gastric bypass (LRYGBP) performed for recalcitrant GERD in MO. Method Patients with recalcitrant GERD and a body mass index (BMI)>35 undergoing LRYGBP were included. Laparoscopic Roux-en-Y gastric bypass included crural repair, creation of a small gastric pouch (30 mL), and intestinal bypass (150 to 180 cm). All patients were followed in clinic and by telephone. Results From February 1999 to April 2001, 57 patients (51 F, 6 M) with a mean age of 43 (range, 22 to 67) and a median BMI of 43 underwent laparoscopic Roux-en-Y gastric bypass. Hiatal hernia or esophagitis, or both, were present in 48, Barrett's in 2. Laparoscopic Roux-en-Y gastric bypass was possible in 52 patients; 5 required open conversion. The median hospital stay was 3 days. Complications included 1 leak, 1 pulmonary emboli, 2 reoperations for internal roux limb hernia, and 7 gastrojejunal strictures. At a mean follow-up of 18 months (range, 3 to 30), all patients report improvement or no symptoms of GERD and a mean weight loss of 40 kg (range, 16 to 70). Quality of life scores (SF-36) were above national norms for physical and mental components. GERD-health related quality of life median score was <1 (scale, 0 to 45, 0=asymptomatic, 45=worse). Conclusion Laparoscopic Roux-en-Y gastric bypass was effective for recalcitrant GERD in MO. Laparoscopic Roux-en-Y gastric bypass also led to weight loss and improvement in other comorbidites. Surgeons with minimally invasive expertise should consider laparoscopic Roux-en-Y gastric bypass for treatment of GERD in the morbidly obese. Source: Gastric Bypass Surgery to Reduce Obesity |