Introduction: Studies evaluating the effectiveness of Laparoscopic Nissen Fundoplication (LNF) in morbidly obese patients have yielded mixed results. Many authors now advocat Laparoscopic RYGB as the surgical treatment of choice for morbidly obese patients with GERD as it has the advantage of treating the GERD as well as the common obesity-related comorbid conditions. The purpose of this study was to compare the GERD-related outcomes of morbidly obese patients treated with LRYGB versus LNF.
Methods: Morbidly obese patients with GERD who underwent either LNF or LRYGB between Nov 2001 and Jul 2009 were analyzed by retrospective review of medical records. GERD-related symptoms included heartburn, regurgitation, waterbrash, dysphagia, globus, bloating, epigastric pain, sinusitis, and respiratory symptoms. Reflux symptoms and antacid use was calulated preop and at 3 month and 12 month follow up. A symptom score was calculated – the lower the score, the less symptoms. Postoperative complications were categorized as mortality, major, and minor. The symptom scores, trends in antacid use, and complications were then compared.
Results: A total of 102 morbidly obese patients with GERD underwent LRYGB while 56 underwent LNF. Both GERD symptoms and antacid usage decreased significantly at 3 month and 12 month follow up in the LRYGB group (Table I).
LRYGB patients with GERD
|Table I||Preop(n=102)||3 month (n=92)||12 month (n=46)||p value preop vs 12 month|
|On Antacid (% of total group)||95.10||66.30||39.13||<0.0001|
|Table II||LNF||LRYGB with GERD||P value|
|Symptom score (preop)||3.75 (n=56)||2.08 (n=102)||p<0.0001|
|Symptom score (12 months)||0.82(n=56)||0.22 (n=46)||p<0.0001|
|On Antacid (preop % of total)||94.64 (n=56)||95.10 (n=102)||p= 0.94|
|On Antacid (12 month % of total)||7.14 (n=56)||39.13 (n=46)||p=0.0013|
When compared with a group of 56 morbidly obese patients undergoing LNF, the LRYGB patients had a lower symptom score (less GERD symptoms ) at 12 months. Antacid use was less in the LNF groupat 12 months compared with the LRYGB group , 7.14% vs 39.13% (Table II). Minor complications were higher in the LRYGB group vs LNF group (20.6 % vs 7.6%). However, major complication rate ( 2.1% vs 3.9%)were similar, and there wereno mortalities in either group.
Conclusions:LRYGBis as effective anantireflux procedure asLNF in the treatment of GERD,with the added benefit of resolving comorbidities associated with obesity. The LRYGB should be the first line treatment in patients with BMI > 35 with GERD.
Program Number: P068