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Lee J, Lee I, Oh Y, Kim JW, Kwon Y, Alromi A, Eledreesi M, Khalid A, Aljarbou W, Park S. Current Status of Anti-Reflux Surgery as a Treatment for GERD. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:518. [PMID: 38541244 PMCID: PMC10972421 DOI: 10.3390/medicina60030518] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/01/2024] [Accepted: 03/20/2024] [Indexed: 06/29/2024]
Abstract
Anti-reflux surgery (ARS) is an efficient treatment option for gastroesophageal reflux disease (GERD). Despite growing evidence of the efficacy and safety of ARS, medications including proton pump inhibitors (PPIs) remain the most commonly administered treatments for GERD. Meanwhile, ARS can be an effective treatment option for patients who need medications continuously or for those who are refractory to PPI treatment, if proper candidates are selected. However, in practice, ARS is often regarded as a last resort for patients who are unresponsive to PPIs. Accumulating ARS-related studies indicate that surgery is equivalent to or better than medical treatment for controlling typical and atypical GERD symptoms. Furthermore, because of overall reduced medication expenses, ARS may be more cost-effective than PPI. Patients are selected for ARS based on endoscopic findings, esophageal acid exposure time, and PPI responsiveness. Although there is limited evidence, ARS may be expanded to include patients with normal acid exposure, such as those with reflux hypersensitivity. Additionally, other factors such as age, body mass index, and comorbidities are known to affect ARS outcomes; and such factors should be considered. Nissen fundoplication or partial fundoplication including Dor fundoplication and Toupet fundoplication can be chosen, depending on whether the patient prioritizes symptom improvement or minimizing postoperative symptoms such as dysphagia. Furthermore, efforts to reduce and manage postoperative complications and create awareness of the long-term efficacy and safety of the ARS are recommended, as well as adequate training programs for new surgeons.
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Affiliation(s)
- Jooyeon Lee
- Department of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Inhyeok Lee
- Division of Foregut Surgery, Korea University College of Medicine, Seoul 02841, Republic of Korea; (I.L.); (Y.K.); (M.E.)
| | - Youjin Oh
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, USA
| | - Jeong Woo Kim
- Division of Foregut Surgery, Korea University College of Medicine, Seoul 02841, Republic of Korea; (I.L.); (Y.K.); (M.E.)
| | - Yeongkeun Kwon
- Division of Foregut Surgery, Korea University College of Medicine, Seoul 02841, Republic of Korea; (I.L.); (Y.K.); (M.E.)
| | - Ahmad Alromi
- Division of Foregut Surgery, Korea University College of Medicine, Seoul 02841, Republic of Korea; (I.L.); (Y.K.); (M.E.)
- The Jordanian Ministry of Health, Department of General Surgery, Princes Hamzh Hospital, Amman 11947, Jordan
| | - Mohannad Eledreesi
- Division of Foregut Surgery, Korea University College of Medicine, Seoul 02841, Republic of Korea; (I.L.); (Y.K.); (M.E.)
- Taif Armed Forces Hospital, Taif 26792, Saudi Arabia
| | - Alkadam Khalid
- Division of Foregut Surgery, Korea University College of Medicine, Seoul 02841, Republic of Korea; (I.L.); (Y.K.); (M.E.)
| | - Wafa Aljarbou
- Division of Foregut Surgery, Korea University College of Medicine, Seoul 02841, Republic of Korea; (I.L.); (Y.K.); (M.E.)
- Dr. Sulaiman Al Habib Hospital, Riyadh 34423, Saudi Arabia
| | - Sungsoo Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul 02841, Republic of Korea; (I.L.); (Y.K.); (M.E.)
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Valdovinos Díaz MA, Amieva-Balmori M, Carmona-Sánchez R, Coss-Adame E, Gómez-Escudero O, González-Martínez M, Huerta-Iga F, Morel-Cerda E, Remes-Troche JM, Tamayo-de la Cuesta JL, Torres-Villalobos G, Valdovinos-García LR, Vázquez-Elizondo G, Villar-Chávez AS, Arenas-Martínez JA. Good clinical practice recommendations for the diagnosis and treatment of gastroesophageal reflux disease. An expert review from the Asociación Mexicana de Gastroenterología. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2024; 89:121-143. [PMID: 38580493 DOI: 10.1016/j.rgmxen.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/06/2023] [Indexed: 04/07/2024]
Abstract
INTRODUCTION Gastroesophageal reflux disease (GERD) is very prevalent in the general population, with a broad spectrum of clinical manifestations, requiring accurate diagnosis and treatment. AIM The aim of this expert review is to establish good clinical practice recommendations for the diagnosis and personalized treatment of GERD. METHODS The good clinical practice recommendations were produced by a group of experts in GERD, members of the Asociación Mexicana de Gastroenterología (AMG), after carrying out an extensive review of the published literature and discussing each recommendation at a face-to-face meeting. This document does not aim to be a clinical practice guideline with the methodology such a document requires. RESULTS Fifteen experts on GERD formulated 27 good clinical practice recommendations for recognizing the symptoms and complications of GERD, the rational use of diagnostic tests and medical treatment, the identification and management of refractory GERD, the overlap with functional disorders, endoscopic and surgical treatment, and GERD in the pregnant woman, older adult, and the obese patient. CONCLUSIONS An accurate diagnosis of GERD is currently possible, enabling the prescription of a personalized treatment in patients with this condition. The goal of the good clinical practice recommendations by the group of experts from the AMG presented in this document is to aid both the general practitioner and specialist in the process of accurate diagnosis and treatment, in the patient with GERD.
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Affiliation(s)
| | - M Amieva-Balmori
- Laboratorio de Fisiología Digestiva y Motilidad Intestinal, Instituto de Investigaciones Médico-Biológicas de la Universidad Veracruzana, Veracruz, Mexico
| | - R Carmona-Sánchez
- Servicio de Gastroenterología, Práctica privada, San Luis Potosí, Mexico
| | - E Coss-Adame
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - O Gómez-Escudero
- Clínica de Gastroenterología, Endoscopia y Motilidad Gastrointestinal, Endoneurogastro, Hospital Ángeles Puebla, Puebla, Mexico
| | - M González-Martínez
- Departamento de Endoscopia, Hospital de Especialidades del CMN Siglo XXI IMSS, Mexico City, Mexico
| | - F Huerta-Iga
- Servicio de Gastroenterología, Hospital Ángeles Torreón, Torreón, Mexico
| | - E Morel-Cerda
- Departamento de Gastroenterología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
| | - J M Remes-Troche
- Laboratorio de Fisiología Digestiva y Motilidad Intestinal, Instituto de Investigaciones Médico-Biológicas de la Universidad Veracruzana, Veracruz, Mexico
| | - J L Tamayo-de la Cuesta
- Servicio de Gastroenterología y Endoscopia Gastrointestinal, Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Culiacán, Sinaloa, Mexico
| | - G Torres-Villalobos
- Cirugía Experimental, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - G Vázquez-Elizondo
- Servicio de Gastroenterología, Centro de Enfermedades Digestivas ONCARE, Monterrey, Mexico
| | - A S Villar-Chávez
- Servicio de Gastroenterología, Hospital Ángeles Acoxpa, Mexico City, Mexico
| | - J A Arenas-Martínez
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Colvin JS, Jalilvand AD, Um P, Noria SF, Needleman BJ, O'Neill SM, Perry KA. Mid-term Outcomes of Nissen Fundoplication Versus Roux-en-y Gastric Bypass for Primary Management of Gastroesophageal Reflux Disease in Patients With Obesity. Surg Laparosc Endosc Percutan Tech 2023; 33:627-631. [PMID: 37671561 DOI: 10.1097/sle.0000000000001215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/18/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION The efficacy and outcomes of laparoscopic Nissen fundoplication (LNF) in patients with obesity is controversial. Specifically, concerns regarding long-term outcomes and recurrence in the setting of obesity has led to interest in laparoscopic Roux-en-Y gastric bypass (RYGB). METHODS In this retrospective cohort study, we studied patients with obesity who underwent either LNF or RYGB for gastroesophageal reflux disease. Baseline demographics, clinical variables, operative outcomes, and symptom severity scores were compared. RESULTS Baseline demographics, operative outcomes, and quality-of-life scores were similar. Proton pump inhibitor usage, quality-of-life, symptom severity scores, and satisfaction with the operation were similar between groups at mid-term follow-up. DISCUSSION RYGB and LNF produced similar improvements in disease-specific quality of life with similar rates of complications, side effects, and need for reoperation. This demonstrates that RYGB and LNF represent possible options for surgical management of gastroesophageal reflux disease in obese patients.
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Affiliation(s)
| | | | - Phoebe Um
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Sabrena F Noria
- Department of Surgery, The Ohio State University Wexner Medical Center
| | | | - Sean M O'Neill
- Division of Minimally Invasive Surgery, University of Michigan, Ann Arbor, MI
| | - Kyle A Perry
- Department of Surgery, The Ohio State University Wexner Medical Center
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Jazi AHD, Mahjoubi M, Shahabi S, Alqahtani AR, Haddad A, Pazouki A, Prasad A, Safadi BY, Chiappetta S, Taskin HE, Billy HT, Kasama K, Mahawar K, Gawdat K, Rheinwalt KP, Miller KA, Kow L, Neto MG, Yang W, Palermo M, Ghanem OM, Lainas P, Peterli R, Kassir R, Puy RV, Da Silva Ribeiro RJ, Verboonen S, Pintar T, Shabbir A, Musella M, Kermansaravi M. Bariatric Evaluation Through AI: a Survey of Expert Opinions Versus ChatGPT-4 (BETA-SEOV). Obes Surg 2023; 33:3971-3980. [PMID: 37889368 DOI: 10.1007/s11695-023-06903-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Recent advancements in artificial intelligence, such as OpenAI's ChatGPT-4, are revolutionizing various sectors, including healthcare. This study investigates the use of ChatGPT-4 in identifying suitable candidates for bariatric surgery and providing surgical recommendations to improve decision-making in obesity treatment amid the global obesity epidemic. METHODS We devised ten patient scenarios, thoughtfully encompassing a spectrum that spans from uncomplicated cases to more complex ones. Our objective was to delve into the decision-making process regarding the recommendation of bariatric surgery. From July 29th to August 10th, 2023, we conducted a voluntary online survey involving thirty prominent bariatric surgeons, ensuring that there was no predetermined bias in the selection of a specific type of bariatric surgery. This survey was designed to collect their insights on these scenarios and gain a deeper understanding of their professional experience and background in the field of bariatric surgery. Additionally, we consulted ChatGPT-4 in two separate conversations to evaluate its alignment with expert opinions on bariatric surgery options. RESULTS In 40% of the scenarios, disparities were identified between the two conversations with ChatGPT-4. It matched expert opinions in 30% of cases. Differences were noted in cases like gastrointestinal metaplasia and gastric adenocarcinoma, but there was alignment with conditions like endometriosis and GERD. CONCLUSION The evaluation of ChatGPT-4's role in determining bariatric surgery suitability uncovered both potential and shortcomings. Its alignment with experts was inconsistent, and it often overlooked key factors, emphasizing human expertise's value. Its current use requires caution, and further refinement is needed for clinical application.
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Affiliation(s)
- Amir Hossein Davarpanah Jazi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Niyaesh Avenue, Sattar Khan Street, Tehran, Iran
| | - Mohammad Mahjoubi
- Clinical Research Development Center, Najafabad Branch, Islamic Azad University, Najafabad, Iran
| | - Shahab Shahabi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Niyaesh Avenue, Sattar Khan Street, Tehran, Iran.
| | | | - Ashraf Haddad
- Gastrointestinal Metabolic and Bariatric Center, GBMC M, Jordan Hospital, Amman, Jordan
| | - Abdolreza Pazouki
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Niyaesh Avenue, Sattar Khan Street, Tehran, Iran
| | - Arun Prasad
- GI, Bariatric and Robotic Surgery Apollo Hospital, New Delhi, India
| | | | - Sonja Chiappetta
- Bariatric and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
| | - Halit Eren Taskin
- Department of General Surgery, Cerrahpaşa Medical Faculty, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | | | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | | | - Khaled Gawdat
- Ain Shams University Faculty of Medicine Department of General Surgery, Cairo, Egypt
| | - Karl Peter Rheinwalt
- Department of Bariatric, Metabolic and Plastic Surgery, St. Franziskus Hospital, Cologne, Germany
| | | | - Lilian Kow
- Department GI Surgery Flinders, University South Australia, Adelaide, Australia
| | | | - Wah Yang
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Mariano Palermo
- Gastrointestinal and Bariatric Surgery, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Panagiotis Lainas
- Department of Digestive and Bariatric Surgery, Metropolitan Hospital, HEAL Academy, Athens, Greece
| | - Ralph Peterli
- Deputy Head of Visceral Surgery and Head of Bariatric-Metabolic Surgery Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland
| | - Radwan Kassir
- Digestive Surgery Unit, University Hospital of La Réunion -Félix Guyon Hospital, Saint-Denis, La Réunion, France
| | - Ramon Vilallonga Puy
- Head Endocrine-Metabolic and Bariatric Surgery Unit, Vall Hebron Barcelona Hospital Campus, Pg. De La Vall d'hebron, 119-129, 08035, Barcelona, Spain
| | - Rui José Da Silva Ribeiro
- General Surgery Department, Multidisciplinary Center for Obesity Treatment - Hospital Lusíadas Amadora, Amadora, Portugal
| | | | - Tadeja Pintar
- UMC Ljubljana, Department of Abdominal Surgery and Medical Faculty, Ljubljana, Slovenia
| | - Asim Shabbir
- National University of Singapore, Singapore, Singapore
| | - Mario Musella
- Advanced Biomedical Sciences Department, "Federico II" University, Naples, Italy
| | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Niyaesh Avenue, Sattar Khan Street, Tehran, Iran
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Balagué C, Nve E, Puértolas N, Rodriguez J. Anti-reflux surgery vs. bariatric surgery as anti-GERD and hiatal hernia treatment in obese patient. New surgical proposals. Cir Esp 2023; 101 Suppl 4:S19-S25. [PMID: 37979937 DOI: 10.1016/j.cireng.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/13/2023] [Indexed: 11/20/2023]
Abstract
The persistence of obesity favors the failure of the Fundoplication (FP) in the treatment of Gastroesophageal Reflux (GER). However, the weight loss obtained with the performance of a Gastric Bypass (GBP) allows a good resolution of symptoms, without increasing the incidence of postoperative complications. All of this leads us to consider that while FP is the indication in patients with BMI < 30, in those patients with BMI > 35, GBP appears to be the procedure of choice. But there is still no position in the case of patients with a BMI between 30 and 35, although we must take into account that an increase in GER recurrence has been described after FP in patients with a BMI > 30. Although Sleeve Gastrectomy (SG) is one of the most frequently used bariatric procedures in recent years, its association with a high rate of postoperative GER has led several authors to propose its performance associated with an anti-reflux procedure in patients with GER symptoms. Likewise, if the existence of an Hiatal Hernia is verified, it must be treated by hiatoplasty, both during the performance of a GBP and a SG. This simultaneous treatment is not associated with an increase in complications.
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Affiliation(s)
- Carmen Balagué
- Unidad de Cirugía Esofagogástrica, Bariátrica y Metabólica, Servicio de Cirugía General, Hospital Universitari Mutua de Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain.
| | - Esther Nve
- Unidad de Cirugía Esofagogástrica, Bariátrica y Metabólica, Servicio de Cirugía General, Hospital Universitari Mutua de Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain
| | - Noelia Puértolas
- Unidad de Cirugía Esofagogástrica, Bariátrica y Metabólica, Servicio de Cirugía General, Hospital Universitari Mutua de Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain
| | - Joaquín Rodriguez
- Unidad de Cirugía Esofagogástrica, Bariátrica y Metabólica, Servicio de Cirugía General, Hospital Universitari Mutua de Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain
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Ibele AR, Nau PN, Galvani C, Roth JS, Goldberg RF, Kurian MS, Khaitan L, Gould J, Pandya YK. Surgeon experience with insurance barriers to offering gastric bypass as an evidence-based operation for pathologic GERD. Surg Endosc 2023; 37:7642-7648. [PMID: 37491660 DOI: 10.1007/s00464-023-10212-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/11/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Obesity is an increasingly prevalent public health problem often associated with poorly controlled gastroesophageal reflux disease. Fundoplication has been shown to have limited long-term efficacy in patients with morbid obesity and does not address additional weight-related co-morbidities. Roux-en-Y gastric bypass (RYGB) is the gold standard operation for durable resolution of GERD in patients with obesity, and is also used as a salvage operation for GERD after prior foregut surgery. Surgeons report access to RYGB as surgical treatment for GERD is often limited by RYGB-specific benefit exclusions embedded within insurance policies, but the magnitude and scope of this problem is unknown. METHODS A 9-item survey evaluating surgeon practice and experience with insurance coverage for RYGB for GERD was developed and piloted by a SAGES Foregut Taskforce working group. This survey was then administered to surgeon members of the SAGES Foregut Taskforce and to surgeons participating in the SAGES Bariatrics and/or Foregut Facebook groups. RESULTS 187 surgeons completed the survey. 89% reported using the RYGB as an anti-reflux procedure. 44% and 26% used a BMI of 35 kg/m2 and 30 kg/m2 respectively as cutoff for the RYGB. 89% viewed RYGB as the procedure of choice for GERD after bariatric surgery. 69% reported using RYGB to address recurrent reflux secondary to failed fundoplication. 74% of responders experienced trouble with insurance coverage at least half the time RYGB was offered for GERD, and 8% reported they were never able to get approval for RYGB for GERD indications in their patient populations. CONCLUSION For many patients, GERD and obesity are related diseases that are best addressed with RYGB. However, insurance coverage for RYGB for GERD is often limited by policies which run contrary to evidence-based medicine. Advocacy is critical to improve access to appropriate surgical care for GERD in patients with obesity.
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Affiliation(s)
- Anna R Ibele
- Department of Surgery, University of Utah School of Medicine, 30 North 1900 East, Salt Lake City Utah, 84132, USA.
| | - Peter N Nau
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Carlos Galvani
- Tulane University School of Medicine, New Orleans, LA, USA
| | - J Scott Roth
- University of Kentucky College of Medicine, Lexington, KY, USA
| | | | | | - Leena Khaitan
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jon Gould
- Medical College of Wisconsin, Milwaukee, WI, USA
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Balagué C, Nve E, Puértolas N, Rodriguez J. Cirugía antirreflujo vs cirugía bariátrica como tratamiento anti-RGE y de la hernia de hiato en el obeso. Nuevas propuestas quirúrgicas. Cir Esp 2023. [DOI: 10.1016/j.ciresp.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Kendrick K, Kothari SN. Updates on Surgical Treatment for Gastroesophageal Reflux Disease. Am Surg 2023:31348231157414. [PMID: 36789472 DOI: 10.1177/00031348231157414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Gastroesophageal reflux disease (GERD) is a common condition that is on the rise. Obesity is one risk factor that has increased in parallel with the rise of GERD. Typical symptoms include heartburn, regurgitation, dysphagia, cough, and chest pain. Patients with typical symptoms are empirically treated with proton pump inhibitors (PPIs). If the diagnosis is not clear, further evaluation is performed with endoscopy, pH monitoring, and esophageal manometry. Untreated GERD increases the risk of esophagitis, esophageal stricture, Barrett's esophagus, and esophageal adenocarcinoma. Treatment begins with lifestyle modification and medical therapy. If these fail, surgical and endoscopic surgical techniques are available, to provide treatment, symptom relief, and reduce long-term PPI use.
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Affiliation(s)
- Katherine Kendrick
- Department of Gastroenterology and Hepatology, 3626Prisma Health Upstate-Greenville Memorial Hospital, Greenville, SC, USA
| | - Shanu N Kothari
- University of South Carolina School of Medicine Greenville, 3626Prisma Health Upstate, Greenville, SC, USA
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Slater BJ, Collings A, Dirks R, Gould JC, Qureshi AP, Juza R, Rodríguez-Luna MR, Wunker C, Kohn GP, Kothari S, Carslon E, Worrell S, Abou-Setta AM, Ansari MT, Athanasiadis DI, Daly S, Dimou F, Haskins IN, Hong J, Krishnan K, Lidor A, Litle V, Low D, Petrick A, Soriano IS, Thosani N, Tyberg A, Velanovich V, Vilallonga R, Marks JM. Multi-society consensus conference and guideline on the treatment of gastroesophageal reflux disease (GERD). Surg Endosc 2023; 37:781-806. [PMID: 36529851 DOI: 10.1007/s00464-022-09817-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is one of the most common diseases in North America and globally. The aim of this guideline is to provide evidence-based recommendations regarding the most utilized and available endoscopic and surgical treatments for GERD. METHODS Systematic literature reviews were conducted for 4 key questions regarding the surgical and endoscopic treatments for GERD in adults: preoperative evaluation, endoscopic vs surgical or medical treatment, complete vs partial fundoplication, and treatment for obesity (body mass index [BMI] ≥ 35 kg/m2) and concomitant GERD. Evidence-based recommendations were formulated using the GRADE methodology by subject experts. Recommendations for future research were also proposed. RESULTS The consensus provided 13 recommendations. Through the development of these evidence-based recommendations, an algorithm was proposed for aid in the treatment of GERD. Patients with typical symptoms should undergo upper endoscopy, manometry, and pH-testing; additional testing may be required for patients with atypical or extra-esophageal symptoms. Patients with normal or abnormal findings on manometry should consider undergoing partial fundoplication. Magnetic sphincter augmentation or fundoplication are appropriate surgical procedures for adults with GERD. For patients who wish to avoid surgery, the Stretta procedure and transoral incisionless fundoplication (TIF 2.0) were found to have better outcomes than proton pump inhibitors alone. Patients with concomitant obesity were recommended to undergo either gastric bypass or fundoplication, although patients with severe comorbid disease or BMI > 50 should undergo Roux-en-Y gastric bypass for the additional benefits that follow weight loss. CONCLUSION Using the recommendations an algorithm was developed by this panel, so that physicians may better counsel their patients with GERD. There are certain patient factors that have been excluded from included studies/trials, and so these recommendations should not replace surgeon-patient decision making. Engaging in the identified research areas may improve future care for GERD patients.
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Affiliation(s)
- Bethany J Slater
- University of Chicago Medicine, 5841 S. Maryland Avenue, MC 4062, Chicago, IL, USA.
| | - Amelia Collings
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rebecca Dirks
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jon C Gould
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alia P Qureshi
- Division of General & GI Surgery, Foregut Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Ryan Juza
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - María Rita Rodríguez-Luna
- Research Institute Against Digestive Cancer (IRCAD) and ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France
| | | | - Geoffrey P Kohn
- Department of Surgery, Monash University, Melbourne, VIC, Australia
| | - Shanu Kothari
- Department of Surgery, Prisma Health, Greenville, SC, USA
| | | | | | - Ahmed M Abou-Setta
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | - Shaun Daly
- Department of Surgery, University of California, Irvine, Orange, CA, USA
| | | | - Ivy N Haskins
- Department of Surgery, University of Nebraska Medical Center, Omaha, USA
| | - Julie Hong
- Department of Surgery, New York Presbyterian/Queens, Queens, USA
| | | | - Anne Lidor
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Virginia Litle
- Section of Thoracic Surgery, Department of Cardiovascular Surgery, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Donald Low
- Virginia Mason Medical Center, Seattle, WA, USA
| | - Anthony Petrick
- Department of General Surgery, Geisinger School of Medicine, Geisinger Medical Center, Danville, PA, USA
| | - Ian S Soriano
- Department of Surgery, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Nirav Thosani
- McGovern Medical School, Center for Interventional Gastroenterology at UTHealth, Houston, TX, USA
| | - Amy Tyberg
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Vic Velanovich
- Division of Gastrointestinal Surgery, Tampa General, Tampa, FL, USA
| | - Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jeffrey M Marks
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Greenberg JA, Palacardo F, Edelmuth RCL, Egan CE, Lee YJ, Schnoll-Sussman FH, Katz PO, Finnerty BM, Fahey TJ, Zarnegar R. Comparative Outcomes of Anti-Reflux Surgery in Obese Patients with Gastroesophageal Reflux Disease 1. J Gastrointest Surg 2022; 27:502-510. [PMID: 36303009 DOI: 10.1007/s11605-022-05455-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/13/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Roux-en-Y gastric bypass (RYGB) has been the preferred operation for obese patients with gastroesophageal reflux disease (GERD); however, some patients are hesitant to undergo bypass. Obese patients have a multifactorial predisposition to GERD, including lower esophageal sphincter (LES) dysfunction and aberrant pressure gradients across their diaphragmatic crura. Among non-obese patients, anti-reflux surgery (ARS) with hiatal hernia (HH) repair and LES augmentation has shown excellent long-term results. We aimed to determine whether patient satisfaction and GERD recurrence differed between obese and non-obese patients who underwent ARS. METHODS Review of patients who underwent ARS between January 2012 and June 2021 was performed. Perioperative and postoperative characteristics were compared across three BMI groups: BMI < 30 kg/m2, 30 kg/m2 ≤ BMI < 35 kg/m2, and BMI ≥ 35 kg/m2. RESULTS Four-hundred thirteen patients were identified, of which 294 (71.1%) had BMI < 30 kg/m2, 87 (21.1%) were 30 kg/m2 ≤ BMI < 35 kg/m2, and 32 (7.7%) had a BMI ≥ 35 kg/m2. Patients with BMI ≥ 35 kg/m2 had higher preoperative manometric and EndoFLIP™ intra-balloon pressure at the LES than those with lower BMIs. This value was increased to a similar level throughout ARS across the three cohorts. Post-operative GERD-specific satisfaction was similar across the three cohorts, as were rates of postoperative reflux and hiatal hernia recurrence on barium swallow; rates of reoperation were low. CONCLUSIONS ARS with HH repair and LES augmentation may be appropriate for select patients across a range of BMIs, including those with a BMI ≥ 35 kg/m2 who are hesitant to undergo RYGB.
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Affiliation(s)
- Jacques A Greenberg
- Department of Surgery, Division of Endocrine & Minimally Invasive Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, K-836, New York, NY, 10065, USA
| | - Federico Palacardo
- Department of Surgery, Division of Endocrine & Minimally Invasive Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, K-836, New York, NY, 10065, USA
| | - Rodrigo C L Edelmuth
- Department of Surgery, Division of Endocrine & Minimally Invasive Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, K-836, New York, NY, 10065, USA
| | - Caitlin E Egan
- Department of Surgery, Division of Endocrine & Minimally Invasive Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, K-836, New York, NY, 10065, USA
| | - Yeon Joo Lee
- Department of Surgery, Division of Endocrine & Minimally Invasive Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, K-836, New York, NY, 10065, USA
| | - Felice H Schnoll-Sussman
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Philip O Katz
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Brendan M Finnerty
- Department of Surgery, Division of Endocrine & Minimally Invasive Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, K-836, New York, NY, 10065, USA
| | - Thomas J Fahey
- Department of Surgery, Division of Endocrine & Minimally Invasive Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, K-836, New York, NY, 10065, USA
| | - Rasa Zarnegar
- Department of Surgery, Division of Endocrine & Minimally Invasive Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, K-836, New York, NY, 10065, USA.
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Gastroesophageal Reflux Disease in Idiopathic Pulmonary Fibrosis: Viewer or Actor? To Treat or Not to Treat? Pharmaceuticals (Basel) 2022; 15:ph15081033. [PMID: 36015181 PMCID: PMC9412643 DOI: 10.3390/ph15081033] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/14/2022] [Accepted: 08/19/2022] [Indexed: 02/07/2023] Open
Abstract
Background: Idiopathic pulmonary fibrosis (IPF) is a rare and severe disease with a median survival of ∼3 years. Several risk factors have been identified, such as age, genetic predisposition, tobacco exposure, and gastro-oesophageal reflux disease (GERD). Prevalence of GERD in IPF is high and may affect 87% of patients, of whom only half (47%) report symptoms. Objective: The aim of this study is to review current evidence regarding the correlation between GERD and IPF and to evaluate the current studies regarding treatments for GERD-IPF. Methods: A review to identify research papers documenting an association between GERD and IPF was performed. Results: We identified several studies that have confirmed the association between GERD and IPF, with an increased acid exposure, risk of gastric aspiration and bile acids levels in these patients. Few studies focused their attention on GERD treatment, showing how antiacid therapy was not able to change IPF evolution. Conclusions: This review investigating the correlation between GERD and IPF has confirmed the hypothesized association. However, further large prospective studies are needed to corroborate and elucidate these findings with a focus on preventative and treatment strategies.
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Roux-en-Y Versus One Anastomosis Gastric Bypass as Redo-Operations Following Sleeve Gastrectomy: A Retrospective Study. World J Surg 2022; 46:855-864. [PMID: 34985543 DOI: 10.1007/s00268-021-06424-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Aim of this study was to improve knowledge about the best conversional bariatric procedure following sleeve gastrectomy (SG). METHODS Data of conversional Roux-en-Y gastric bypass (RYGB) and of one anastomosis gastric bypass (OAGB) after SG were collected prospectively and analyzed retrospectively. Weight loss parameters, gastroesophageal reflux disease (GERD) and comorbidities outcomes were recorded. RESULTS Total of 123 patients (90 female, mean age 44 ± 0.9 years, mean body mass index (BMI) 42 ± 0.8 kg/m2) had either RYGB (n = 68) or OAGB (n = 55). Perioperative mortality was zero. Mean surgery time was significantly shorter for OAGB (168 ± 7.2 vs. 201 ± 6.8 min). Perioperative complication rates were not significantly (ns) different between RYGB and OAGB. Total body weight loss (TBWL) in RYGB and OAGB was 18 ± 2.2% and 18 ± 1.9% (12 months) and 18 ± 3.0% and 23 ± 2.6% (24 months; ns), respectively. Length of (individualized) biliopancreatic limb (BPL) correlated significantly with weight loss. Remission rates after 12 months of RYGB and OAGB for arterial hypertension (aHt) were 89% and 92%, for obstructive sleep apnea (OSAS) 56% and 82%, for Type 2 diabetes mellitus (T2DM) 100% and 92%, for osteoarthritis 64% and 85% and for GERD 89% versus 87% (ns), respectively. Nutritional deficiencies were comparable in RYGB (n = 11) and OAGB (n = 14) group (ns). CONCLUSION Both RYGB and OAGB are effective conversional procedures after SG, leading to comparable TBWL, BMI-loss and high remission rates of comorbidities including GERD. Significantly shorter operation times were in favor of OAGB. BPL, which was longer in OAGB was significantly related to higher %TBWL and %BMI-loss compared to RYGB.
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ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol 2022; 117:27-56. [PMID: 34807007 PMCID: PMC8754510 DOI: 10.14309/ajg.0000000000001538] [Citation(s) in RCA: 308] [Impact Index Per Article: 154.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/30/2021] [Indexed: 01/30/2023]
Abstract
Gastroesophageal reflux disease (GERD) continues to be among the most common diseases seen by gastroenterologists, surgeons, and primary care physicians. Our understanding of the varied presentations of GERD, enhancements in diagnostic testing, and approach to patient management have evolved. During this time, scrutiny of proton pump inhibitors (PPIs) has increased considerably. Although PPIs remain the medical treatment of choice for GERD, multiple publications have raised questions about adverse events, raising doubts about the safety of long-term use and increasing concern about overprescribing of PPIs. New data regarding the potential for surgical and endoscopic interventions have emerged. In this new document, we provide updated, evidence-based recommendations and practical guidance for the evaluation and management of GERD, including pharmacologic, lifestyle, surgical, and endoscopic management. The Grading of Recommendations, Assessment, Development, and Evaluation system was used to evaluate the evidence and the strength of recommendations. Key concepts and suggestions that as of this writing do not have sufficient evidence to grade are also provided.
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Abstract
Patients with obesity who present with gastroesophageal reflux disease (GERD) require a nuanced approach. Those with lower body mass index (BMI) (less than 33) can be counseled on weight loss, and if successful may be approached with laparoscopic fundoplication. Those who are unable to achieve weight loss or those who present with a BMI greater than or equal to 35 should proceed with laparoscopic Roux-en-Y gastric bypass (LRYGB). Conversion to LRYGB from sleeve gastrectomy is a safe and effective way to manage GERD after sleeve gastrectomy.
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Giulini L, Razia D, Mittal SK. Redo fundoplication and early Roux-en-Y diversion for failed fundoplication: a 3-year single-center experience. Surg Endosc 2021; 36:3094-3099. [PMID: 34231073 DOI: 10.1007/s00464-021-08610-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/14/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Redo fundoplication (RF) and Roux-en-Y diversion (RNY) are both accepted surgical treatments after failed fundoplication. However, due to higher reported morbidity, RNY is more commonly performed only after several surgical failures. In our experience, RNY at an earlier point of the disease progression seems to be related with better outcomes. The aim of this study was to investigate this aspect by comparing the results between RF and RNY performed by a single surgeon over 3 years at our institution. METHODS A prospectively maintained database was reviewed to identify patients who underwent RF or RNY at our institution between 2016 and 2019 by a single surgeon (author SKM). Patients with previous bariatric surgery were excluded. RESULTS Of 43 patients, 28 underwent RF and 15 underwent RNY (mean body mass index 28.6 and 32.7 kg/m2, respectively, p = 0.01). The number of previous antireflux surgeries for the RF and RNY groups was 1 (82% vs 80%, p > 0.99), 2 (18% vs 7%, p = 0.4), and more than 2 (0% vs 13%, p = 0.1). RNY took longer than RF (median, 165 vs 137 min, p = 0.02), but both groups had a median estimated blood loss of 50 ml (p = 0.82). There was no difference in intraoperative complications (25% vs 20% for RF and RYN, respectively, p > 0.99). Postoperative complications were more common in the RF than in the RYN group (21% vs 7%, p = 0.39). Median hospital stay was 3 days for both groups (p = 0.78). At short-term follow-up, the mean quality of life score was similar for the RF and RYN groups (11.5 vs 12.2, p = 0.8). CONCLUSIONS RNY diversion, if performed by experienced hands and at an earlier point of disease progression, has comparable perioperative morbidity to RF and should be considered as a feasible and safe option for definitive treatment of failed antireflux surgery.
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Affiliation(s)
- Luca Giulini
- St. Joseph's Hospital and Medical Center, Norton Thoracic Institute, 500 W Thomas Rd, Suite 500, Phoenix, AZ, 85013, USA
| | - Deepika Razia
- St. Joseph's Hospital and Medical Center, Norton Thoracic Institute, 500 W Thomas Rd, Suite 500, Phoenix, AZ, 85013, USA
| | - Sumeet K Mittal
- St. Joseph's Hospital and Medical Center, Norton Thoracic Institute, 500 W Thomas Rd, Suite 500, Phoenix, AZ, 85013, USA.
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA.
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Ahuja A, Mahawar K. Bariatric surgery in patients with gastroesophageal reflux disease and/or hiatus hernia. MINERVA CHIR 2020; 75:345-354. [PMID: 32773756 DOI: 10.23736/s0026-4733.20.08486-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Gastroesophageal reflux disease (GERD) and hiatus hernia (HH) are frequently encountered comorbidities in patients seeking bariatric and metabolic surgery (BMS) for obesity. sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB) are the three commonest bariatric procedures performed worldwide. The purpose of this review was to analyze and compare the data on outcomes of these three procedures in patients with GERD and/or HH. EVIDENCE ACQUISITION We examined published English language scientific literature available on PubMed for data comparing SG, RYGB, and OAGB with specific focus on GERD outcomes and outcomes in those with GERD and/or HH. EVIDENCE SYNTHESIS Several authors have addressed the outcome of GERD after bariatric surgery. There have been randomized control trials and comparative studies in the literature comparing the results of these procedure. But very few studies have exclusively looked into the outcome of different procedures in patients with pre-existing GERD and/or HH. In this narrative review, we evaluate pros and cons of three commonest bariatric procedures worldwide in this subgroup of patients seeking BMS. We also suggest an algorithm on the basis of our experience and the available data in scientific literature. CONCLUSIONS Though RYGB is the best anti reflux procedure it is associated with significant higher morbidity/mortality as compared to SG and OAGB. These two procedures can be used in the majority of patients with GERD and/or HH seeking BMS with an acceptance that some patients will need conversion to RYGB in the long term.
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Affiliation(s)
- Anmol Ahuja
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, New Delhi, India -
| | - Kamal Mahawar
- Bariatric Unit, Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK.,Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
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Kim M, Navarro F, Eruchalu CN, Augenstein VA, Heniford BT, Stefanidis D. Minimally Invasive Roux-en-Y Gastric Bypass for Fundoplication failure offers Excellent Gastroesophageal Reflux Control. Am Surg 2020. [DOI: 10.1177/000313481408000726] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Roux-en-Y gastric bypass (RYGB) may represent a superior alternative to reoperative fundoplication in patients with symptomatic failure. Our goal was to assess early outcomes of patients after RYGB for failed fundoplication. Records of patients who underwent fundoplication takedown and RYGB from March 2007 to June 2013 were reviewed for demographics, comorbidities, operative findings, and perioperative outcomes. Data are reported as medians (range). Forty-five patients who had undergone 64 prior antireflux procedures (range, one to three fundoplications) were identified. Median patient age was 56 years (range, 25 to 72 years) with a body mass index of 33 kg/m2 (range, 22 to 51 kg/m2). Most patients had comorbidities: hypertension (60%), anxiety/ depression (44.4%), dyslipidemia (33.3%), asthma (31%), obstructive sleep apnea (26.7%), arthritis (22.2%), and diabetes (11.1%). Median symptom-free interval was 3 years (range, 0 to 25 years). All patients had an anatomic reason for failure: 83 per cent had a hiatal hernia and 35 per cent had a slipped Nissen fundoplication. The procedures were accomplished laparoscopically in 28, robotically in 13, and open in four cases. Median operative time was 367 minutes (range, 190 to 600 minutes) and estimated blood loss averaged 100 mL (range, 25 to 500 mL). Five patients (11%) required reoperation: one for an anastomotic leak, one for anastomotic obstruction, and three for early obstruction resulting from adhesions. Two patients developed respiratory failure requiring prolonged mechanical ventilation. Length of stay averaged four days (range, 1 to 33 days) with two readmissions: one for melena and one for vomiting and dehydration; neither required intervention. There was no mortality. At 11 months of follow-up (range, 2.3 to 54 months), 93.3 per cent of patients were symptom-free. When primary fundoplication for gastroesophageal reflux disease fails, fundoplication takedown and RYGB can be accomplished safely with minimally invasive techniques. The conversion to a RYGB has an acceptable perioperative morbidity and excellent early symptom control, and, therefore, should be considered for reoperative patients gastroesophageal reflux disease.
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Affiliation(s)
- Mimi Kim
- From the Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Fernando Navarro
- From the Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Chukwuma N. Eruchalu
- From the Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Vedra A. Augenstein
- From the Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - B. Todd Heniford
- From the Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Dimitrios Stefanidis
- From the Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, North Carolina
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18
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Suter M. Gastroesophageal Reflux Disease, Obesity, and Roux-en-Y Gastric Bypass: Complex Relationship—a Narrative Review. Obes Surg 2020; 30:3178-3187. [DOI: 10.1007/s11695-020-04690-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Spann MD, Harrison NJ, English WJ, Bolduc AR, Aher CV, Williams DB, Hawkins AT. Efficacy and Safety of Recurrent Paraesophageal Hernia Repair with Roux-en-Y Gastric Bypass. Am Surg 2020. [DOI: 10.1177/000313482008600336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Roux-en-Y gastric bypass (RYGB) has been explored as a revisional option to failed paraesophageal hernia (PEH) repair with fundoplication, particularly in patients suffering from obesity. However, few studies have assessed long-term outcomes of RYGB with revisional PEH repairin regard to acid-suppressing medication use. We retrospectively identified 19 patients who underwent revisional PEH repair with RYGB between 2011 and 2018. The median operative time was 232 minutes with a median hospital length of stay of two days. The median length of follow-up was 24 months. Two patients (10.5%) had complications in the first 30 days, and five patients (26.3%) had complications within one year. Of the 12 patients on preoperative acid suppression, 6 (50%) were either off medication or on reduced dose at 12 months. The median BMI decrease was 14.4 kg/m2at 12 months and did not change significantly afterward. Although rates of acid-suppression medication use did not change overall after revisional PEH repair with RYGB, patients experienced successful long-term management of morbid obesity and sustained weight loss. Revisional PEH repair with RYGB is a safe and effective option, with a complication rate comparable with the reported rates after revisional foregut procedures such as revisional Nissen fundoplication.
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Affiliation(s)
- Matthew D. Spann
- Department of Surgery, Section of Bariatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Noah J. Harrison
- Vanderbilt University School of Medicine, Nashville, Tennessee; and
| | - Wayne J. English
- Department of Surgery, Section of Bariatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aaron R. Bolduc
- Department of Surgery, Section of Bariatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chetan V. Aher
- Department of Surgery, Section of Bariatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - D. Brandon Williams
- Department of Surgery, Section of Bariatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alexander T. Hawkins
- Department of Surgery, Section of Colon and Rectal Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Nau P, Jackson HT, Aryaie A, Ibele A, Shouhed D, Lo Menzo E, Kurian M, Khaitan L. Surgical management of gastroesophageal reflux disease in the obese patient. Surg Endosc 2019; 34:450-457. [PMID: 31720811 DOI: 10.1007/s00464-019-07231-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 10/28/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) affects two thirds of the American population. Obesity is also a disease that affects two thirds of the population. The pathophysiology of reflux disease is reasonably understood, however, the degree to which obesity affects this disease remains poorly defined. Therefore the approach to GERD in the obese patient requires special attention and its own algorithm. METHODS A literature search was conducted to consolidate the current available literature on GERD and its management in the obese. In addition, the authors reviewed the literature and present expert opinion on controversial topics. RESULTS It is well established that GERD is increased in obesity and the pathophysiology is reviewed. Management options for GERD are discussed, with a focus on the obese population. Management strategies including fundoplication and gastric bypass are discussed. In addition, bariatric surgery in the setting of GERD is also reviewed. CONCLUSIONS Currently this is an extremely controversial topic and this white paper presents a strong review of the literature to help guide the management of this challenging disease in this population. Expert recommendations are given throughout the paper based upon the current available data.
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Affiliation(s)
- P Nau
- Department of Surgery, Carver College of Medicine, Iowa City, IA, USA
| | - H T Jackson
- George Washington School of Medicine and Life Sciences, Washington, DC, USA
| | - A Aryaie
- Department of Surgery, Texas Tech, Lubbock, TX, USA
| | - A Ibele
- University of Utah College of Medicine, Salt Lake City, UT, USA
| | - D Shouhed
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - E Lo Menzo
- Department of Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - M Kurian
- New York University School of Medicine, New York, NY, USA
| | - L Khaitan
- Cleveland Medical Center, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
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Baretta G, Al-Mulla AE, Lopes MAG, Feistler RS, Cambi MPC, de Paula Loureiro M. Laparoscopic Roux-en-Y Gastric Bypass After Gastroesophageal Reflux Disease Surgical Procedure: Analysis of 85 Consecutive Patients with Pre- and Post-Operative Endoscopy Control. J Laparoendosc Adv Surg Tech A 2019; 30:40-43. [PMID: 31368842 DOI: 10.1089/lap.2019.0413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Most of the obese patients undergoing an anti-reflux operation experience recurrence of gastroesophageal reflux disease (GERD). Laparoscopic Roux-en-Y gastric bypass (LRNYGB) has been accepted as the bariatric surgery of choice for a previous GERD-operated obese patients. Methods: We present 85 consecutive patients from a single institution, previously submitted to antireflux surgery and then to LRNYGB. Preoperative endoscopy was carried out in all patients; 49 (57.64%) patients had findings of fundoplication failure or signs of persistent GERD, of those 20 (40.81%) with esophagitis. Results: From the bypass, per or postoperative minor to moderate complications occurred in 12 patients (14.11%): 2 (2.35%) conversions to laparotomy, 1 (1.17%) melena, 8 (9.41%) stenosis of gastrojejunostomy, treated by a simple endoscopic dilatation with a balloon, and 1 (1.17%) gastrogastric fistula. A follow-up endoscopy of 79 of 85 (92.9%) patients was carried out after 6 months of LRNYGB. Eight of 79 (10.12%) patients had persistent esophagitis that represented 40% (8 of 20 patients) of persistent reflux esophagitis even after LRNYGB. All of them were men. Conclusion: LRNYGB after laparoscopic fundoplication is a feasible procedure with an excepted higher rate of complications because of the complexity of the procedure. Nevertheless esophagitis still persisted in many of those patients.
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Affiliation(s)
- Giorgio Baretta
- Bariatric Unit, Jacques Perissat Institute of Minimally Invasive Surgery, Vita Batel Hospital, Curitiba, Brazil
| | | | | | | | | | - Marcelo de Paula Loureiro
- Biotechnology Division, Jacques Perissat Institute of Minimally Invasive Surgery, Positivo University of Curitiba, Curitiba, Brazil
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Abstract
PURPOSE OF REVIEW Gastroesophageal reflux disease (GERD) affects millions of people worldwide. Many patients with medically refractory symptoms ultimately undergo antireflux surgery, most often with a laparoscopic fundoplication. Symptoms related to GERD may persist or recur. Revisional surgery is necessary in some patients. RECENT FINDINGS A reoperative fundoplication is the most commonly performed salvage procedure for failed fundoplication. Although redo fundoplication has been reported to have increased risk of morbidity compared with primary cases, increasing experience with the minimally invasive approach to reoperative surgery has significantly improved patient outcome with acceptable resolution of reflux symptoms in the majority of patients. Recurrence of reflux symptoms after an initial fundoplication requires a thorough work-up and a thoughtful approach. While reoperative fundoplication is the most common procedure performed, there are other options and the treatment should be tailored to the patient, their history, and the mechanism of fundoplication failure.
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Affiliation(s)
- Semeret Munie
- Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Hassan Nasser
- Department of General Surgery, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - Jon C Gould
- Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
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Mendes-Filho AM, Godoy ESN, Alhinho HCAW, Galvão-Neto MDP, Ramos AC, Ferraz ÁAB, Campos JM. FUNDOPLICATION CONVERSION IN ROUX-EN-Y GASTRIC BYPASS FOR CONTROL OF OBESITY AND GASTROESOPHAGEAL REFLUX: SYSTEMATIC REVIEW. ACTA ACUST UNITED AC 2018; 30:279-282. [PMID: 29340554 PMCID: PMC5793148 DOI: 10.1590/0102-6720201700040012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/21/2017] [Indexed: 12/12/2022]
Abstract
Introduction: Obesity is related with higher incidence of gastroesophageal reflux disease.
Antireflux surgery has inadequate results when associated with obesity, due
to migration and/or subsequent disruption of antireflux wrap. Gastric
bypass, meanwhile, provides good control of gastroesophageal reflux. Objective: To evaluate the technical difficulty in performing gastric bypass in
patients previously submitted to antireflux surgery, and its effectiveness
in controlling gastroesophageal reflux. Methods: Literature review was conducted between July to October 2016 in Medline
database, using the following search strategy: (“Gastric bypass” OR
“Roux-en-Y”) AND (“Fundoplication” OR “Nissen ‘) AND (“Reoperation” OR
“Reoperative” OR “Revisional” OR “Revision” OR “Complications”). Results: Were initially classified 102 articles; from them at the end only six were
selected by exclusion criteria. A total of 121 patients were included, 68
women. The mean preoperative body mass index was 37.17 kg/m² and age of
52.60 years. Laparoscopic Nissen fundoplication was the main prior
antireflux surgery (70.58%). The most common findings on
esophagogastroduodenoscopy were esophagitis (n=7) and Barrett’s esophagus
(n=6); the most common early complication was gastric perforation (n=7), and
most common late complication was stricture of gastrojejunostomy (n=9).
Laparoscopic gastric bypass was performed in 99 patients, with an average
time of 331 min. Most patients had complete remission of symptoms and
efficient excess weight loss. Conclusion: Although technically more difficult, with higher incidence of complications,
gastric bypass is a safe and effective option for controlling
gastroesophageal reflux in obese patients previously submitted to antireflux
surgery, with the added benefit of excess weight loss.
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Affiliation(s)
| | | | | | | | | | - Álvaro Antônio Bandeira Ferraz
- Post-Graduation Program in Surgery, Federal University of Pernambuco, Recife, PE.,Department of Surgery and Clinical Medicine, Federal University of Pernambuco, Recife, PE, Brazil
| | - Josemberg Marins Campos
- Post-Graduation Program in Surgery, Federal University of Pernambuco, Recife, PE.,Department of Surgery and Clinical Medicine, Federal University of Pernambuco, Recife, PE, Brazil
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Akiyama J, Kuribayashi S, Baeg MK, Bortoli N, Valitova E, Savarino EV, Kusano M, Triadafilopoulos G. Current and future perspectives in the management of gastroesophageal reflux disease. Ann N Y Acad Sci 2018; 1434:70-83. [DOI: 10.1111/nyas.13850] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/28/2018] [Accepted: 04/06/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Junichi Akiyama
- Division of Gastroenterology and HepatologyNational Center for Global Health and Medicine Tokyo Japan
| | - Shiko Kuribayashi
- Division of Gastroenterology and Hepatology, Integrative Center of Internal MedicineGunma University Hospital Maebashi Japan
| | - Myong Ki Baeg
- Division of Gastroenterology, Department of Internal MedicineCatholic Kwandong University College of Medicine, International St. Mary's Hospital Incheon South Korea
| | - Nicola Bortoli
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa Pisa Italy
| | - Elen Valitova
- Department of Upper Gastrointestinal Tract DisordersClinical Scientific Centre Moscow Russia
| | - Edoardo V. Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and GastroenterologyUniversity of Padua Padua Italy
| | - Motoyasu Kusano
- Division of Gastroenterology and Hepatology, Integrative Center of Internal MedicineGunma University Hospital Maebashi Japan
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Roux-En-Y gastric bypass following failed fundoplication. Surg Endosc 2018; 32:3517-3524. [DOI: 10.1007/s00464-018-6072-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 01/17/2018] [Indexed: 12/11/2022]
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Mandeville Y, Van Looveren R, Vancoillie PJ, Verbeke X, Vandendriessche K, Vuylsteke P, Pattyn P, Smet B. Moderating the Enthusiasm of Sleeve Gastrectomy: Up to Fifty Percent of Reflux Symptoms After Ten Years in a Consecutive Series of One Hundred Laparoscopic Sleeve Gastrectomies. Obes Surg 2018; 27:1797-1803. [PMID: 28190216 DOI: 10.1007/s11695-017-2567-z] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has become a popular one-stage bariatric procedure with a proven efficacy on weight loss. However, the relationship between LSG and gastroesophageal reflux disease (GERD) remains a subject of debate. The objective is to determine the long-term effect of LSG on weight loss and reflux disease. METHODS A retrospective analysis of 100 consecutive patients who underwent an LSG between January 2005 and March 2009 was performed. The effect of LSG on weight evolution and the relationship between preoperative and postoperative GERD symptoms and PPI dependency was analyzed. RESULTS A mean follow-up of 8.48 years (range 6.1-10.3) was achieved. We observed a long-term % excess weight loss (%EWL) of 60%. A significant increase in reflux symptoms and use of PPIs was seen. Seventeen percent suffered from reflux disease preoperatively versus 50% at the end of the postoperative follow-up (RR = 2.5882, 95% CI [1.6161-4.1452], p value = 0.0001). The chance of developing de novo reflux after LSG was 47.8% (32/67). Reflux disease was present in 7 of the 26 patients who underwent a secondary Roux-en-Y gastric bypass (RYGB). In four of these seven patients, reflux disease disappeared completely after the secondary RYGB (57.1%). CONCLUSIONS A satisfactory long-term effect on weight loss was achieved. However, a significant increase in GERD and PPI dependency after LSG was noted. New onset GERD was seen in more than 40% of the study population. Conversion to RYGB is a good option in patients with refractory reflux disease after LSG.
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Affiliation(s)
| | | | | | | | | | | | - Paul Pattyn
- AZ Delta Ziekenhuis, Wilgenstraat 2, Roeselare, Belgium
| | - Bart Smet
- AZ Delta Ziekenhuis, Wilgenstraat 2, Roeselare, Belgium
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Abstract
PURPOSE OF REVIEW This paper provides an overview of current and future surgical interventions available for the management of gastroesophageal reflux disease (GERD) beyond the well established and recognized fundoplication. Review the current indications and outcomes of these surgical procedures. RECENT FINDINGS Fundoplication has been a cornerstone of the surgical management of GERD. However, other effective surgical options exist and can be considered based on prior interventions as well as patient, anatomical or other factors. These options are intended to address some of the shortcomings or potential complications of fundoplication such as symptom recurrence, dysphagia, or gas bloating, for example. Alternative procedures to fundoplication include magnetic sphincter augmentation, electrical stimulation and Roux-en-Y gastric bypass. The indication for surgical management remains failure of or inability to tolerate medical therapy.
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Martin del Campo SE, Chaudhry UI, Kanji A, Suzo AJ, Perry KA. Laparoscopic Nissen fundoplication controls reflux symptoms and improves disease-specific quality of life in patients with class I and II obesity. Surgery 2017; 162:1048-1054. [DOI: 10.1016/j.surg.2017.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/26/2017] [Accepted: 07/13/2017] [Indexed: 02/07/2023]
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Obeid NR, Altieri MS, Yang J, Park J, Price K, Bates A, Pryor AD. Patterns of reoperation after failed fundoplication: an analysis of 9462 patients. Surg Endosc 2017; 32:345-350. [DOI: 10.1007/s00464-017-5682-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/19/2017] [Indexed: 02/06/2023]
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Increased Esophageal Exposure to Weakly Acidic Reflux 5 Years After Laparoscopic Roux-en-Y Gastric Bypass. Ann Surg 2017; 264:871-877. [PMID: 27429035 DOI: 10.1097/sla.0000000000001775] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To evaluate the long-term effects of laparoscopic Roux-en-Y Gastric Bypass (LRYGB) on gastroesophageal function. BACKGROUND LRYGB is considered the weight loss procedure of choice for obese patients with gastroesophageal reflux disease (GERD). However, long-term instrumental evaluations of GERD after LRYGB are not available. METHODS Morbidly obese patients selected for LRYGB were included in a prospective study. We performed clinical evaluation with GERD-HRQoL questionnaire, upper endoscopy, esophageal manometry, and 24-hour impedance pH (24-hour MII-pH) monitoring preoperatively and at 12 and 60 months after surgery. This trial is registered with ClinicalTrials.gov (no. NCT02618044). RESULTS From May 2006 to May 2009, 86 patients entered the study and 72 (84%) completed the 5-year protocol. At preoperative 24-hour MII-pH monitoring, 54 patients (group A) had normal values, whereas 32 (group B) had diagnosis of GERD: 23 had acidic reflux, whereas 9 had combined reflux [acidic + weakly acidic reflux (WAR)]. The groups were similar in preoperative age, body mass index, and comorbidities. At 12 and 60 months, significant improvement in questionnaire scores was observed in group B patients. No manometric changes occurred in both groups; 24-hour MII-pH monitoring showed a significant reduction in acid exposure, but an increase of WAR in both group A (from 0% to 52% to 74%) and group B (from 35% to 42% to 77%). At long-term follow-up, esophagitis was found in 14 group A (30%) and in 18 group B patients (69%) (P < 0.001). CONCLUSIONS LRYGB allows to obtain an effective GERD symptom amelioration and a reduction in acid exposure. However, 3 out 4 patients present with distal esophagus exposure to WAR.
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Attia SG. Laparoscopic Sleeve Gastrectomy and Crural Repair as a Treatment of Morbid Obesity Associated with Gastroesophageal Reflux. Electron Physician 2017; 9:3529-3534. [PMID: 28243403 PMCID: PMC5308491 DOI: 10.19082/3529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/16/2016] [Indexed: 01/10/2023] Open
Abstract
Objective The aim of this study was to evaluate the Laparoscopic Sleeve Gastrectomy (LSG) with simultaneous crural repair in treatment of morbid obesity associated with gastroesophageal reflux disease. Methods This prospective observational study was carried out from September 2012 to July 2016 in Al-Azhar University Hospital (Egypt). The study was conducted on 53 patients, 14 males (26.4%) and 39 females (73.6%) with the mean age 36.2 years (range 18–52 years), presenting with morbid obesity and reflux disease either symptomatic patients or asymptomatic (Endoscopic & Manometric), their mean Body Mass Index (BMI) was 50.1 kg/m2 (range 40–62 kg/m2), who underwent LSG and antireflux procedure (crural repair). Results Excess weight Loss (EWL); the mean EWL at 6 months postoperatively was 46.3%, at 12 months was 54%, and at 18 months was 61%. Also, we found that, preoperative co-morbidities are resolved by 53% and improved by 23%. Reflux symptoms were absent in 30 patients (56 %), improved in 14 patients (26.4 %), but persistent in 7 patients (13.2 %). Conclusion Laparoscopic crural closure, during LSG, represents a valuable option for the treatment of morbid obesity and gastroesophageal reflux, and can result in favorable outcomes in terms of weight loss and gastroesophageal reflux disease (GERD) symptoms control.
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Affiliation(s)
- Sameh Gabr Attia
- M.D., Assistant Professor, Department of surgery, Faculty of Medicine, Alazhar University, Cairo-Egypt
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Duke MC, Farrell TM. Surgery for Gastroesophageal Reflux Disease in the Morbidly Obese Patient. J Laparoendosc Adv Surg Tech A 2016; 27:12-18. [PMID: 27858583 DOI: 10.1089/lap.2016.29013.mcd] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The prevalence of gastroesophageal reflux disease (GERD) has mirrored the increase in obesity, and GERD is now recognized as an obesity-related comorbidity. There is growing evidence that obesity, specifically central obesity, is associated with the complications of chronic reflux, including erosive esophagitis, Barrett's esophagus, and esophageal adenocarcinoma. While fundoplication is effective in creating a competent gastroesophageal junction and controlling reflux in most patients, it is less effective in morbidly obese patients. In these patients a bariatric operation has the ability to correct both the obesity and the abnormal reflux. The Roux-en-Y gastric bypass is the preferred procedure.
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Affiliation(s)
- Meredith C Duke
- Department of Surgery, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Timothy M Farrell
- Department of Surgery, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
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De Luca M, Angrisani L, Himpens J, Busetto L, Scopinaro N, Weiner R, Sartori A, Stier C, Lakdawala M, Bhasker AG, Buchwald H, Dixon J, Chiappetta S, Kolberg HC, Frühbeck G, Sarwer DB, Suter M, Soricelli E, Blüher M, Vilallonga R, Sharma A, Shikora S. Indications for Surgery for Obesity and Weight-Related Diseases: Position Statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg 2016; 26:1659-96. [PMID: 27412673 PMCID: PMC6037181 DOI: 10.1007/s11695-016-2271-4] [Citation(s) in RCA: 182] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Maurizio De Luca
- Director Department of Surgery, Montebelluna Treviso Hospital, Montebelluna, Treviso, Italy.
| | | | - Jacques Himpens
- The European School of Laparoscopic Surgery, Brussels, Belgium
| | | | | | | | - Alberto Sartori
- Director Department of Surgery, Montebelluna Treviso Hospital, Montebelluna, Treviso, Italy
| | | | | | | | | | - John Dixon
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | | | | | | | - Michel Suter
- University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Mattias Blüher
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | | | - Arya Sharma
- Obesity Research Management, University of Alberta, Edmonton, Canada
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Bächler T, le Roux CW, Bueter M. How do patients' clinical phenotype and the physiological mechanisms of the operations impact the choice of bariatric procedure? Clin Exp Gastroenterol 2016; 9:181-9. [PMID: 27524917 PMCID: PMC4965261 DOI: 10.2147/ceg.s87205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Bariatric surgery is currently the most effective option for the treatment of morbid obesity and its associated comorbidities. Recent clinical and experimental findings have challenged the role of mechanical restriction and caloric malabsorption as the main mechanisms for weight loss and health benefits. Instead, other mechanisms including increased levels of satiety gut hormones, altered gut microbiota, changes in bile acid metabolism, and/or energy expenditure have been proposed as explanations for benefits of bariatric surgery. Beside the standard proximal Roux-en-Y gastric bypass and the biliopancreatic diversion with or without duodenal switch, where parts of the small intestine are excluded from contact with nutrients, resectional techniques like the sleeve gastrectomy (SG) have recently been added to the armory of bariatric surgeons. The variation of weight loss and glycemic control is vast between but also within different bariatric operations. We surveyed members of the Swiss Society for the Study of Morbid Obesity and Metabolic Disorders to assess the extent to which the phenotype of patients influences the choice of bariatric procedure. Swiss bariatric surgeons preferred Roux-en-Y gastric bypass and SG for patients with type 2 diabetes mellitus and patients with a body mass index >50 kg/m2, which is consistent with the literature. An SG was preferred in patients with a high anesthetic risk or previous laparotomy. The surgeons’ own experience was a major determinant as there is little evidence in the literature for this approach. Although trends will come and go, evidence-based medicine requires a rigorous examination of the proof to inform clinical practice.
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Affiliation(s)
- Thomas Bächler
- Department of General and Visceral Surgery, Fribourg Cantonal Hospital (HFR), Fribourg, Switzerland
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland; Gastrosurgical Laboratory, University of Gothenburg, Gothenburg, Sweden
| | - Marco Bueter
- Division of Visceral and Transplantation Surgery, University Hospital Zurich (USZ), Zürich, Switzerland
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Ospanov O, Maleckas A, Orekeshova A. Gastric greater curvature plication combined with Nissen fundoplication in the treatment of gastroesophageal reflux disease and obesity. Medicina (B Aires) 2016; 52:283-290. [DOI: 10.1016/j.medici.2016.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/08/2016] [Accepted: 08/26/2016] [Indexed: 12/26/2022] Open
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Association of Body Mass Index (BMI) with Patterns of Fundoplication Failure: Insights Gained. J Gastrointest Surg 2015; 19:1943-8. [PMID: 26242886 DOI: 10.1007/s11605-015-2907-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/28/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Obesity has been implicated as an important risk factor for fundoplication failure. However, the mechanism of fundoplication in obese patients is not fully understood. Our objective is to evaluate the patterns of failure in relation to the body mass index (BMI) undergoing re-operative intervention after failed fundoplication. METHODS After Institutional Review Board approval, the patients who underwent re-operative intervention for failed fundoplication between November 2008 and December 2013 were identified. Patients were classified into three groups: non-obese, obese, and morbidly obese (<30, 30-35, >35 BMI, respectively). Pre-operative assessment and operative procedure performed were compared between the groups. RESULTS One hundred twenty-four patients satisfied study criteria. Non-obese patients (53.2 %) had significantly more dysphagia as an indication for re-operative procedure (obese 31.6 %, p < 0.05; morbidly 16.7 %, p < 0.05). Obese and morbidly obese patients had significantly higher incidence of recurrent hiatal hernia than non-obese patients (88.7 vs. 65.6 %, p < 0.05). Morbidly obese patients had significantly higher incidence of disrupted fundoplication than non-obese patients (41.7 vs. 19.4 %, p < 0.05). CONCLUSION Similar anatomical failure patterns of state of fundoplication and recurrent hiatal hernia were noted between obese patients and morbidly obese patients and were distinct from non-obese patients.
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Simple versus reinforced cruroplasty in patients submitted to concomitant laparoscopic sleeve gastrectomy: prospective evaluation in a bariatric center of excellence. Surg Endosc 2015; 30:2374-81. [DOI: 10.1007/s00464-015-4487-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/01/2015] [Indexed: 12/11/2022]
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Fischer L, Wekerle AL, Bruckner T, Wegener I, Diener MK, Frankenberg MV, Gärtner D, Schön MR, Raggi MC, Tanay E, Brydniak R, Runkel N, Attenberger C, Son MS, Türler A, Weiner R, Büchler MW, Müller-Stich BP. BariSurg trial: Sleeve gastrectomy versus Roux-en-Y gastric bypass in obese patients with BMI 35-60 kg/m(2) - a multi-centre randomized patient and observer blind non-inferiority trial. BMC Surg 2015; 15:87. [PMID: 26187377 PMCID: PMC4506636 DOI: 10.1186/s12893-015-0072-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 07/08/2015] [Indexed: 02/08/2023] Open
Abstract
Background Roux-en-Ygastric bypass (RYGB) and sleeve gastrectomy (SG) rank among the most frequently applied bariatric procedures worldwide due to their positive risk/benefit correlation. A systematic review revealed a similar excess weight loss (EWL) 2 years postoperatively between SG and RYGB. However, there is a lack of randomized controlled multi-centre trials comparing SG and RYGB, not only concerning EWL, but also in terms of remission of obesity-related co-morbidities, gastroesophageal reflux disease (GERD) and quality of life (QoL) in the mid- and long-term. Methods The BariSurg trial was designed as a multi-centre, randomized controlled patient and observer blind trial. The trial protocol was approved by the corresponding ethics committees of the centres. To demonstrate EWL non-inferiority of SG compared to RYGB, power calculation was performed according to a non-inferiority study design. Morbidity, mortality, remission of obesity-related co-morbidities, GERD course and QoL are major secondary endpoints. 248 patients between 18 and 70 years, with a body mass index (BMI) between 35–60 kg/m2 and indication for bariatric surgery according to the most recent German S3-guidelines will be randomized. The primary and secondary endpoints will be assessed prior to surgery and afterwards at discharge and at the time points 3–6, 12, 24, 36, 48 and 60 months postoperatively. Discussion With its five year follow-up, the BariSurg-trial will provide further evidence based data concerning the impact of SG and RYGB on EWL, remission of obesity-related co-morbidities, the course of GERD and QoL. Trial registration The trial protocol has been registered in the German Clinical Trials Register DRKS00004766.
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Affiliation(s)
- Lars Fischer
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Anna-Laura Wekerle
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Inga Wegener
- Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus K Diener
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | | | - Daniel Gärtner
- Department of General and Visceral Surgery, Städtisches Krankenhaus Karlsruhe, Moltkestraße 90, 76133, Karlsruhe, Germany
| | - Michael R Schön
- Department of General and Visceral Surgery, Städtisches Krankenhaus Karlsruhe, Moltkestraße 90, 76133, Karlsruhe, Germany
| | - Matthias C Raggi
- Department of General and Visceral Surgery, Agaplesion Bethesda Krankenhaus Stuttgart, Hohenheimer Straße 21, 70184, Stuttgart, Germany
| | - Emre Tanay
- Department of General and Visceral Surgery, Agaplesion Bethesda Krankenhaus Stuttgart, Hohenheimer Straße 21, 70184, Stuttgart, Germany
| | - Rainer Brydniak
- Department of General and Visceral Surgery, Schwarzwald- Baar Klinikum, Klinikstraße 11, 78052, Villingen-Schwenningen, Germany
| | - Norbert Runkel
- Department of General and Visceral Surgery, Schwarzwald- Baar Klinikum, Klinikstraße 11, 78052, Villingen-Schwenningen, Germany
| | - Corinna Attenberger
- Department of Surgery, Caritas-Krankenhaus St. Josef, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Min-Seop Son
- Department of General and Visceral Surgery, Johanniter Krankenhaus, Johanniter GmbH, Johanniterstraße 3, 53113, Bonn, Germany
| | - Andreas Türler
- Department of General and Visceral Surgery, Johanniter Krankenhaus, Johanniter GmbH, Johanniterstraße 3, 53113, Bonn, Germany
| | - Rudolf Weiner
- Department of Bariatric Surgery and Metabolic Surgery, Sana Klinikum Offenbach GmbH, Starkenburgring 66, 63069, Offenbach, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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Nadaleto BF, Herbella FAM, Patti MG. Gastroesophageal reflux disease in the obese: Pathophysiology and treatment. Surgery 2015; 159:475-86. [PMID: 26054318 DOI: 10.1016/j.surg.2015.04.034] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 04/07/2015] [Accepted: 04/28/2015] [Indexed: 12/12/2022]
Abstract
Obesity is a condition that has increased all over the world in the last 3 decades. Overweight and gastroesophageal reflux disease (GERD) are related. GERD may have different causative factors in the obese compared with lean individuals. This review focuses on the proper treatment for GERD in the obese based on its pathophysiology. Increased abdominal pressure may play a more significant role in obese subjects with GERD than the defective esophagogastric barrier usually found in nonobese individuals. A fundoplication may be used to treat GERD in these individuals; however, outcomes may be not as good as in nonobese patients and it does not act on the pathophysiology of the disease. All bariatric techniques may ameliorate GERD symptoms owing to a decrease in abdominal pressure secondary to weight loss. However, some operations may lead to a disruption of natural anatomic antireflux mechanisms or even lead to slow gastric emptying and/or esophageal clearance and thus be a refluxogenic procedure. Roux-en-Y gastric bypass decreases both acid and bile reflux from the stomach into the esophagus. On the other hand, gastric banding is a refluxogenic operation, and sleeve gastrectomy may show different outcomes based on the anatomy of the gastric tube.
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Affiliation(s)
- Barbara F Nadaleto
- Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Fernando A M Herbella
- Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Marco G Patti
- Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, IL
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Gastroesophageal reflux disease and laparoscopic sleeve gastrectomy: a physiopathologic evaluation. Ann Surg 2015; 260:909-14; discussion 914-5. [PMID: 25379861 DOI: 10.1097/sla.0000000000000967] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) in morbidly obese patients. BACKGROUND Symptomatic GERD is considered by many a contraindication to LSG. However, studies evaluating the relationship between LSG and GERD by 24-hour pH monitoring are lacking. METHODS Consecutive morbidly obese patients selected for LSG were included in a prospective clinical study. Gastroesophageal function was evaluated using a clinical validated questionnaire, upper endoscopy, esophageal manometry, and 24-hour pH monitoring before and 24 months after LSG. This trial is registered with ClinicalTrials.gov (no. NCT02012894). RESULTS From June 2009 to September 2011, a total of 71 patients were enrolled into the study; 65 (91.5%) completed the 2-year protocol. On the basis of preoperative 24-hour pH monitoring, patients were divided into group A (pathologic, n=28) and group B (normal, n=37). Symptoms improved in group A, with the Gastroesophageal Reflux Disease Symptom Assessment Scale score decreasing from 53.1±10.5 to 13.1±3.5 (P<0.001). The DeMeester score and total acid exposure (% pH<4) decreased in group A patients (DeMeester score from 39.5±16.5 to 10.6±5.8, P<0.001; % pH<4 from 10.2±3.7 to 4.2±2.6, P<0.001). Real "de novo" GERD occurred in 5.4% group B patients. No significant changes in lower esophageal sphincter pressure and esophageal peristalsis amplitude were found in both groups. CONCLUSIONS LSG improves symptoms and controls reflux in most morbidly obese patients with preoperative GERD. In obese patients without preoperative evidence of GERD, the occurrence of "de novo" reflux is uncommon. Therefore, LSG should be considered an effective option for the surgical treatment of obese patients with GERD.
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Abstract
Patient satisfaction with primary antireflux surgery is high, but a small percentage of patients experience recurrent reflux and dysphagia, requiring reoperation. The major anatomic causes of failed fundoplication are slipped fundoplication, failure to identify a short esophagus, and problems with the wrap. Minimally invasive surgery has become more common for these procedures. Options for surgery include redo fundoplication with hiatal hernia repair if needed, conversion to Roux-en-Y anatomy, or, as a last resort, esophagectomy. Conversion to Roux-en-Y anatomy has a high rate of success, making this approach an important option in the properly selected patient.
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Affiliation(s)
- Brandon T Grover
- Department of General and Vascular Surgery, Gundersen Health System, 1900 South Avenue, C05-001, La Crosse, WI 54601, USA
| | - Shanu N Kothari
- Department of General and Vascular Surgery, Gundersen Health System, 1900 South Avenue, C05-001, La Crosse, WI 54601, USA.
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Roux-en-Y Near Esophagojejunostomy for Failed Antireflux Operations: Outcomes in More Than 100 Patients. Ann Thorac Surg 2014; 98:1905-11; discussion 1911-3. [PMID: 25442998 DOI: 10.1016/j.athoracsur.2014.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 07/07/2014] [Accepted: 07/07/2014] [Indexed: 12/12/2022]
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Wakeam E, Wee J, Lebenthal A, Ali SO, Gilbert RJ, Bueno R. Does BMI predict recurrence or complications after reoperative reflux surgery? Review of a single center's experience and a comparison of outcomes. J Gastrointest Surg 2014; 18:1965-73. [PMID: 25227639 DOI: 10.1007/s11605-014-2656-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 09/02/2014] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Obese patients who fail primary surgical management of gastroesophageal reflux present a significant challenge. We reviewed our outcomes with reoperative reflux surgery in obese (body mass index (BMI) >30) and nonobese patients to identify predictors of failure and complications and evaluate whether reoperative fundoplication is the ideal solution for obese patients. METHODS We conducted a retrospective review of consecutive patients undergoing reoperation for failed anti-reflux surgery between 1994 and 2013. Medical record review identified preoperative, intraoperative, and postoperative characteristics. Short- and long-term outcomes for obese and nonobese patients were compared using descriptive statistics and logistic regression. RESULTS One hundred and nine interventions were identified in 95 patients. Clinical characteristics were similar between obese and nonobese patients. Eighty-eight (83.8%) patients underwent laparoscopic repair, 87 (79.8%) of whom had a Nissen fundoplication. Obese patients were more likely to fail via a slipped wrap (64.7 vs. 40.0%; p = 0.02). No differences were seen in short- or long-term symptomatic relief or major complications. In bivariate analysis, short-term outcomes were predicted by preoperative albumin <3.5 mg/dL (odds ratio (OR), 0.27 (confidence interval (CI), 0.08-0.96); p = 0.04) and laparoscopic conversion (OR, 0.19 (CI, 0.04-1.03); p = 0.05). Laparoscopic conversion was associated with major complications (OR, 7.33 (CI, 1.33-40.55); p = 0.02). BMI was a significant predictor for long-term outcome (p = 0.03) as a continuous variable in sensitivity analyses. CONCLUSIONS Obese patients with recurrence after failed anti-reflux operation may be safely treated with a repeat operation. Our data indicate no difference in outcomes for patients with BMI >30, underscoring the importance of preoperative discussion as to the best approach: reoperative fundoplication or a gastric bypass.
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Affiliation(s)
- E Wakeam
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA,
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46
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Zerbib F, Sifrim D, Tutuian R, Attwood S, Lundell L. Modern medical and surgical management of difficult-to-treat GORD. United European Gastroenterol J 2014; 1:21-31. [PMID: 24917938 DOI: 10.1177/2050640612473964] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 12/13/2012] [Indexed: 12/15/2022] Open
Abstract
Approximately 30-40% of patients taking proton pump inhibitors (PPIs) for presumed gastro-oesophageal reflux (GOR) symptoms do not achieve adequate symptom control, especially when no oesophageal mucosal breaks are present at endoscopy and when extra-oesophageal symptoms are concerned. After failure of optimization of medical therapy, a careful work up is mandatory that aims at determining whether symptoms are related to GOR or not. Most patients with refractory symptoms do not have GOR-related symptoms. Some may have symptoms related to weakly acidic reflux and/or oesophageal hypersensitivity. Baclofen is currently the only antireflux compound available as add-on therapy to PPIs, but its poor tolerability limits its use in clinical practice. There is room for pain modulators in patients with hypersensitive oesophagus and functional heartburn. Antireflux surgery is a suitable option in patients responding to medical therapy who want to avoid taking medication or if persisting symptoms can be clearly attributed to poorly controlled GOR.
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Affiliation(s)
- Frank Zerbib
- Gastroenterology and Hepatology Department, Saint André Hospital, CHU Bordeaux and Bordeaux Segalen University, Bordeaux, France
| | - Daniel Sifrim
- Barts and The London School of Medicine and Dentistry, Wingate Institute for Neurogastroenterology, Queen Mary University of London, UK
| | - Radu Tutuian
- Division of Gastroenterology, University Clinic of Visceral Surgery and Medicine, Bern University Hospital, Inselspital Bern, Bern, Switzerland
| | - Stephen Attwood
- Department of Surgery, North Tyeneside Hospital, Durham University, Northumbria Healthcare, United Kingdom
| | - Lars Lundell
- Department of Surgery, Gastrocentrum, Karolinska University Hospital, Stockholm, Sweden
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47
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El-Hadi M, Birch DW, Gill RS, Karmali S. The effect of bariatric surgery on gastroesophageal reflux disease. Can J Surg 2014; 57:139-44. [PMID: 24666452 DOI: 10.1503/cjs.030612] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Obesity is an epidemic that is known to play a role in the development of gastroesophageal reflux disease (GERD). Studies have shown that increasing body mass index plays a role in the incompetence of the gastroesophageal junction and that weight loss and lifestyle modifications reduce the symptoms of GERD. As a method of producing effective and sustainable weight loss, bariatric surgery plays a major role in the treatment of obesity. We reviewed the literature on the effects of different types of bariatric surgery on the symptomatic relief of GERD and its complications. Roux-en- Y gastric bypass was considered an effective method to alleviate symptoms of GERD, whereas laparoscopic sleeve gastrectomy appeared to increase the incidence of the disease. Adjustable gastric banding was seen to initially improve the symptoms of GERD; however, a subset of patients experienced a new onset of GERD symptoms during long-term follow-up. The literature suggests that different surgeries have different impacts on the symptomatology of GERD and that careful assessment may be needed before performing bariatric surgery in patients with GERD.
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Affiliation(s)
- Mustafa El-Hadi
- The Department of Surgery, University of Alberta, Edmonton, Alta
| | - Daniel W Birch
- The Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandria Hospital, Edmonton, Alta
| | - Richdeep S Gill
- The Department of Surgery, University of Alberta, Edmonton, Alta
| | - Shahzeer Karmali
- The Department of Surgery, University of Alberta, and the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandria Hospital, Edmonton, Alta
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Varban OA, Hawasli AA, Carlin AM, Genaw JA, English W, Dimick JB, Wood MH, Birkmeyer JD, Birkmeyer NJO, Finks JF. Variation in utilization of acid-reducing medication at 1 year following bariatric surgery: results from the Michigan Bariatric Surgery Collaborative. Surg Obes Relat Dis 2014; 11:222-8. [PMID: 24981934 DOI: 10.1016/j.soard.2014.04.027] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/01/2014] [Accepted: 04/09/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Morbidly obese patients undergoing bariatric surgery have high rates of gastroesophageal reflux and are often treated with acid-reducing medications (ARM) such as proton pump inhibitors or H2-blockers. The objective of this study was to evaluate the effect of bariatric procedures on the utilization of ARM. We analyzed data from the clinical registry of the Michigan Bariatric Surgery Collaborative on 35,477 patients undergoing bariatric surgery between January 2006 and October 2012 who completed both baseline and 1-year follow-up surveys. Procedures included laparoscopic adjustable gastric banding (LAGB, n=2,627), Roux-en-Y gastric bypass (RYGB, n=6,410), sleeve gastrectomy (SG, n=1,567), and biliopancreatic diversion with duodenal switch (BPD/DS, n=162). METHODS Rates of ARM at 1 year by procedure type were compared using logistic regression analysis. Models were adjusted for patient characteristics, baseline co-morbidities, weight loss, and hiatal hernia repair. RESULTS Overall ARM use at baseline was 37.7% and declined to 29.6% at 1 year after bariatric surgery. The proportion of patients starting an ARM at 1 year when they were not using one at baseline by procedure was LAGB (13.9%), RYGB (19.2%), SG (21.6%), and BPD/DS (26.7%). The proportion of patients discontinuing an ARM at 1 year when they were using one at baseline by procedure was LAGB (55.6%), RYGB (56.2%), SG (37.3%), and BPD/DS (42.1%). Compared with LAGB on multivariable analysis, the likelihood of ARM use at 1 year was higher for SG (OR 1.70, 95% CI 1.45-1.99) and BDP/DS (OR 1.53, CI .97-2.40) but not different for RYGB (OR 1.02, CI .90-1.16). CONCLUSION Overall ARM use decreases after bariatric surgery; however, it is not uniform and depends on procedure type. SG is a significant predictor for ARM use at 1 year.
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Affiliation(s)
- Oliver A Varban
- Value Partnerships Program, Blue Cross and Blue Shield of Michigan, and the Center for Healthcare Outcomes and Policy and Department of Surgery, University of Michigan, Ann Arbor, Michigan.
| | - Abdelkader A Hawasli
- Department of Surgery, St. John Providence Health System, St. Clair Shores, Michigan
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Jeffrey A Genaw
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Wayne English
- Department of Surgery, Marquette General Hospital, Marquette, Michigan
| | - Justin B Dimick
- Value Partnerships Program, Blue Cross and Blue Shield of Michigan, and the Center for Healthcare Outcomes and Policy and Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michael H Wood
- Department of Surgery, Detroit Medical Center, Detroit, Michigan
| | - John D Birkmeyer
- Value Partnerships Program, Blue Cross and Blue Shield of Michigan, and the Center for Healthcare Outcomes and Policy and Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Nancy J O Birkmeyer
- Value Partnerships Program, Blue Cross and Blue Shield of Michigan, and the Center for Healthcare Outcomes and Policy and Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jonathan F Finks
- Value Partnerships Program, Blue Cross and Blue Shield of Michigan, and the Center for Healthcare Outcomes and Policy and Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Bächler T, Schiesser M, Lutz TA, le Roux CW, Bueter M. Where to begin and where to end? Preoperative assessment for patients undergoing metabolic surgery. Dig Surg 2014; 31:25-32. [PMID: 24819494 DOI: 10.1159/000354553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Bariatric surgery is the most effective treatment of obesity and its associated diseases like type 2 diabetes mellitus. Given the obesity epidemic and the efficacy of surgical treatment, the number of surgical weight loss procedures has grown in recent years. Nevertheless, there is little consensus regarding the extent of preoperative investigations required prior to patients undergoing surgery. This article aims to discuss the available evidence on which preoperative tests are useful for the detection and treatment of conditions such as venous thromboembolism, obstructive sleep apnea syndrome and Helicobacter pylori-positive gastritis prior to an operation. The present literature suggests that only a few preoperative investigations are essential, but that preoperative multidisciplinary care is beneficial.
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Affiliation(s)
- Thomas Bächler
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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50
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Telem DA, Altieri M, Gracia G, Pryor AD. Perioperative outcome of esophageal fundoplication for gastroesophageal reflux disease in obese and morbidly obese patients. Am J Surg 2014; 208:163-8. [PMID: 24881017 DOI: 10.1016/j.amjsurg.2014.02.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 12/25/2013] [Accepted: 02/27/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND To determine the perioperative safety of esophageal fundoplication for gastroesophageal reflux disease (GERD) in patients with body mass index (BMI) ≥ 35 kg/m(2). METHODS A retrospective review of 4,231 patients who underwent fundoplication for GERD from 2005 to 2009 was performed. Patients were identified via National Surgical Quality Improvement Program and grouped by BMI < 35 versus BMI ≥ 35 kg/m(2). Univariate analysis compared 30-day outcomes. RESULTS Of the 4,231 patients, 3,496 (83%) had BMI < 35 kg/m(2) and 735 (17%) had BMI ≥ 35 kg/m(2). Mean BMI for each cohort was 27.9 versus 39.1, respectively. Patients with BMI ≥ 35 kg/m(2) had significantly longer operative times (129.7 vs 118 minutes, P < .0001) and increased American Society of Anesthesiologists scores (2.43 vs 2.3, P = .001). The overall complication rate was 1.96%. No difference was demonstrated by BMI in complication rate or hospital length of stay. Increased American Society of Anesthesiologists score, diabetes, black race, longer operative time, and intraoperative transfusion significantly increased postoperative complication rates. CONCLUSIONS No increased risk is conferred to morbidly obese patients who undergo fundoplication for GERD management. This study identified independent patient risk factors for postoperative complication following esophageal fundoplication.
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Affiliation(s)
- Dana A Telem
- Division of Laparoscopic, Bariatric and Advanced GI Surgery, Stony Brook University Medical Center, 100 Nichols Road, Stony Brook, NY 11794, USA.
| | - Maria Altieri
- Division of Laparoscopic, Bariatric and Advanced GI Surgery, Stony Brook University Medical Center, 100 Nichols Road, Stony Brook, NY 11794, USA
| | - Gerald Gracia
- Division of Laparoscopic, Bariatric and Advanced GI Surgery, Stony Brook University Medical Center, 100 Nichols Road, Stony Brook, NY 11794, USA
| | - Aurora D Pryor
- Division of Laparoscopic, Bariatric and Advanced GI Surgery, Stony Brook University Medical Center, 100 Nichols Road, Stony Brook, NY 11794, USA
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