Symptomatic and Clinical Improvement in Morbidly Obese Patients with Gastroesophageal Reflux Disease Following Roux-en-Y Gastric Bypass |
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Authors: | Sherman C Smith MD Charles B Edwards MD Gerald N Goodman MD |
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Institution: | (1) Rocky Mountain Associated Physicians, Salt Lake City, Utah, USA;(2) Rocky Mountain Associated Physicians, Salt Lake City, Utah, USA;(3) Rocky Mountain Associated Physicians, Salt Lake City, Utah, USA |
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Abstract: | Background: Patients who suffer with gastroesophageal reflux Disease (GERD) endure a worsening of symptoms as their weight
increases. When medical treatment of this condition in the morbidly obese patients fails, surgical intervention may be indicated.
Choosing a procedure which not only helps achieve weight control but which also relieves symptoms and complications of GERD
is the goal. We present a review of patients who have undergone Roux-en-Y Gastric Bypass (RYGBP) and related procedures for
this disease. Methods: One hundred eighty-eight patients undergoing surgery for morbid obesity and for GERD in 1992-1996 were
contacted by mail or phone. All of these patients had undergone preoperative esophagogastroduodenoscopy to grade the severity
of their disease. Their preoperative symptoms were compared to those experienced postoperatively. Results: One hundred thirty
patients underwent a RYGBP with modified Hill fundopexy, 22 patients underwent a distal gastrectomy with modified Hill fundopexy,
8 patients underwent distal gastrectomy alone and 28 patients underwent RYGBP alone. There have been no deaths. There were
nine surgical complications, eight early and one at 2.5 years postoperation. Follow-up is 4-48 months. The average BMI dropped
from 43 to 30.2 kg/m2. Whereas all patients were on some form of medical therapy before surgery, only 14 reported the need for medication postoperatively.
Conclusions: Surgical intervention for weight control and treatment of GERD has been highly successful in our experience both
with respect to weight control and to the reduction of reflux symptoms. Depending upon endoscopic and operative findings a
RYGBP with or without an antireflux procedure can provide dramatic improvement. Gastrectomy with antireflux modifications
is appropriate in selected cases. |
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Keywords: | Gastrectomy gastric bypass gastric fundopexy gastroesophageal reflux disease hiatal hernia repair morbid obesity |
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