Gastroesophageal Reflux in Morbidly Obese Patients Treated with Gastric Banding or Vertical Banded Gastroplasty

Abstract

ObjectiveTo compare gastric banding (GB) and vertical banded gastroplasty (VBG) with respect to postsurgical gastroesophageal reflux (GER) and to investigate the role of preexisting hiatus hernia. Summary Background DataGB and VBG have for a long time been used in the treatment of morbidly obese patients. The introduction of laparoscopic techniques has renewed the interest in these operations. The long-term results after GB have, however, been poor. VBG was suggested to have antireflux properties because it involves repositioning and retaining the gastroesophageal junction within the abdomen and constructing an elongated intraabdominal tube. MethodsForty-three morbidly obese patients accepted for GB or VBG were evaluated for GER before and at regular intervals after surgery. All patients were questioned about adverse symptoms and need for antireflux medication. Both before and after surgery, 24-hour pH measurement and upper gastrointestinal endoscopies were performed. ResultsThe prevalence of heartburn and acid regurgitation among patients treated with GB increased from 14% and 13% to 63% and 69%, respectively. Heartburn and acid regurgitation were present before surgery in 32% and 23% of patients treated with VBG, percentages unchanged by the procedure. The 24-hour reflux time increased significantly from 6.4% to 30.9% in patients treated with GB but was essentially unchanged in patients treated with VBG. The prevalence of esophagitis after GB and VBG was 75% and 20%. Acid inhibitors were needed in 81% of patients after GB and 29% of patients after VBG. ConclusionsThe prevalence of GER was unchanged by VBG, but VBG did not demonstrate antireflux properties. The incidence of GER increased markedly after GB.

Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass

“…Bariatric operations, which are intended primarily to induce weight loss in the morbidly obese, have also been considered as possible antire¯ux operations because they result in weight loss, the restoration of cardioesophageal competence, or perhaps work by other mechanisms. VBG appears to be ineective in controlling GERD and may actually promote GERD [15,23]. One recent study by Balsiger et al 2 showed a high rate of GERD after VBG, requiring conversion to Roux-en-Y gastric bypass [2].…”

Gastroesophageal reflux disease and esophageal motility in morbidly obese patients submitted to laparoscopic adjustable silicone gastric banding or laparoscopic vertical banded gastroplasty

“…Øvrebø et al [31] observed an initial worsening of GERD symptoms after LASGB and an increase in reflux score. Reflecting these changes, 24-h pH monitoring data showed a marked increase in esophageal acid exposure.…”

“…Øvrebø et al [31] found that in LVBGtreated patients, heartburn and acid regurgitation did not increase and that the reflux score was unchanged after surgery. The LVBG procedure was not followed by significant changes in esophageal acid exposure.…”

“…To date, conflicting results have come mostly from small retrospective series with short-term follow-up evaluation, with some claiming significant improvement, others showing no difference, and still others reporting worsening of GERD symptoms and findings after a bariatric restrictive procedure [9,29,30]. The effect on esophageal motility also is unclear [31].…”

Preoperative Upper Gastrointestinal Testing Can Help Predicting Long-term Outcome After Gastric Banding for Morbid Obesity

“…GB has been shown to have various effects on reflux. It can act as an antireflux procedure or it can enhance GERD [8][9][10][11][12][13]. GB also rapidly alters esophageal motility, with a decrease in the amplitude of contractions in the lower esophagus as soon as 9 months after surgery [13].…”