ANTI-REFLUX PROCEDURES AFTER ROUX-EN-Y GASTRIC BYPASS.

David Motola,Muhammad A Jawad,Rena C Moon,Muhammad Ghanem,Andre F Teixeira,Ibrahim M Zeini

doi:10.1590/0102-672020210002e1614

Abstract

ABSTRACT Background: Roux-en-Y gastric bypass (RYGB) has been the choice of bariatric procedure for patients with symptomatic reflux - and is known to be effective in reducing the need for anti-reflux medication postoperatively. However, a small number of RYGB patients can still develop severe reflux symptoms that require a surgical intervention. Aim:To examine and describe the patient population that requires an anti-reflux procedure after RYGB evaluating demographics, characteristics, symptoms and diagnosis Methods: A retrospective chart review was performed on 32 patients who underwent a hiatal hernia repair and/or Nissen fundoplication after RYGB Jul 1st, 2014 and Dec 31st, 2019. Patients were identified using the MBSAQIP database and their electronic medical records were reviewed. Results: Most patients were female (n=29, 90.6%). The mean age was 52.8 years and the mean body mass index (BMI) was 34.1 kg/m2 at the time of anti-reflux procedure. Patients underwent the anti-reflux procedure at a mean of 7.9 years after the RYGB procedure. The mean percentage of excess BMI loss during the time between RYGB and anti-reflux procedure was 63.4%. Conclusions: Female patients with a significant weight loss may develop a severe reflux symptoms years after RYGB. Complaints of reflux after RYGB should not be overlooked. Careful follow-up and appropriate treatment (including surgical intervention) is needed for this population.

Highlights

Laparoscopic sleeve gastrectomy (LSG) became the most commonly performed bariatric procedure according to American Society for Metabolic and Bariatric Surgery[11]
Up to 70% of preoperative bariatric patients suffer from gastroesophageal reflux disease (GERD) symptoms and between 5-50% of obese individuals are reported to have hiatal hernia[2,4]
Our study shows that some patients can develop reflux symptoms after Roux-en-Y gastric bypass (RYGB) severe enough to require a surgical intervention

Summary

Introduction

Laparoscopic sleeve gastrectomy (LSG) became the most commonly performed bariatric procedure according to American Society for Metabolic and Bariatric Surgery[11]. Roux-en-Y gastric bypass (RYGB) still constituted 17% of all bariatric procedures in 201811. Up to 70% of preoperative bariatric patients suffer from gastroesophageal reflux disease (GERD) symptoms and between 5-50% of obese individuals are reported to have hiatal hernia[2,4]. Obese individuals are more prone to hiatal hernias and esophagitis secondary to unique changes in physiology as it pertains to increased intra-abdominal pressure[7]. They are more than four times as likely to have hiatal hernias than normal weight patients[26]. Several studies reviewed preoperative workup for these entities and ways to manage them at the time of initial bypass[2,13,24]

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Discussion

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