Gastroesophageal Reflux Disease and Obesity
Gastroesophageal reflux disease (GERD) is a significant public health problem affecting up to 40% of the American adult population. Even though a direct cause-effect relationship between obesity and GERD has not been clearly established, obesity is often associated with GERD.
As much as 55% of morbidly obese patients presenting for laparoscopic Roux-en-Y gastric bypass (LRYGB) have symptoms of chronic GERD.
LRYGB is currently recommended as an attractive alternative to antireflux surgery for the primary treatment of GERD in morbidly obese patients. Recent evidence suggests that LRYGB is the most effective antireflux procedure in morbidly obese patients.
Lap-BandŽ procedure may not be a good option for patients with GERD as it can increase the GERD symptoms.
In addition, GERD is often associated with a hernia at the esophageal hiatus (hiatal hernia). Dr. Raftopoulos routinely performs a hiatal hernia repair in conjunction with the gastric bypass as it improves the patient's outcome.
In contrast, repair of a hiatal hernia at the time of a Lap-BandŽ procedure may compromise the proper placement of the band and often is not performed for this reason.
Furthermore LRYGB has a role for obese patients with GERD who had a previously failed antireflux surgery. According to a study that Dr. Raftopoulos conducted, this highly complex revision surgery can be safely performed laparoscopically.
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Bariatric Center at Saint Francis |
