The Mini-Gastric Bypass Surgery

# 4672 ROUX-EN-Y GASTRIC BYPASS AS A REMEDIAL OPERATION FOR GASTROESOPHAGEAL REFLUX (GER) AFTER VERTICAL BANDED GASTROPLASTY (VBG)
B M Balsiger, M M Murr, Michael G Sarr, Mayo Clin, Rochester, MN

Symptomatic GER is common after VBG (Mayo Clin Proc 1991). AIM: Determine safety and efficacy of Roux-en-Y gastric bypass (RYGB) in treatment of symptomatic GER after VBG. METHODS: We evaluated prospectively collected data on 3 men and 22 women (age: 49±3 yr, mean±sem) who underwent revisional bariatric surgery because of severe symptomatic GER. Only 4 of 25 patients had reflux symptoms prior to VBG. Mean duration of GER symptoms after VBG was 35±8 mo. All patients had severe heartburn with regurgitation and/or vomiting; 14 patients (55%) remained markedly symptomatic despite use of anti-reflux medications. Endoscopic findings in 24 patients included esophagitis (58%), Barrett's esophagus (28%), pouchitis (29%), gastritis (21%), and one stomal ulcer. Nine patients had a hiatal hernia, and another 3 had pouch enlargement. Only 7 of the 25 patients (28%) had evidence of stenosis at the pouch outlet as documented by endoscopy or contrast studies. Median interval between VBG and revisional surgery was 7 yr. Median follow-up (complete in all 25) after RYGB was 18 (3-102) mo. RESULTS: All patients underwent revision to a RYGB without mortality. Postoperative complications occurred in 6 patients: pneumonia (2), wound infection (2), prolonged drainage of defunctionalized stomach (G tube) (1) and others (2). Median hospitalization was 7 (5-43) days. 

At follow-up, 24/25 (96%) are completely or near completely symptom-free, 3 of whom still take anti-acids intermittently. 

Rare vomiting occurred in 4 patients. 

Another patient reported intermittent bile reflux (4%). 

Five patients had endoscopic follow-up; complete resolution of associated esophagitis (not Barrett's) was documented. Body-mass index (kg/m2) was 33±2 prior to and 28±2 after RYGB (p=0.001). CONCLUSION: Symptoms of GER are common after VBG. Revisional operative treatment affords prompt and sustained relief from GER symptoms in patients with stenotic as well as anatomically intact VBG. Conversion to RYGB promotes further weight loss and can be accomplished with minimal morbidity; moreover, the maladaptive eating (vomiting, etc) induced by VBG is relieved.

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Warning: Gastric Bypass Surgery is a MAJOR surgical procedure. It can be associated with significant risks and complications, up to and including death. Weight loss surgery is a rapidly developing area of medicine. Bariatric surgery is filled with controversy. It is very important to take a careful and deliberate approach to considering surgery for the treatment of obesity.  

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