Roux-en-Y gastric bypass versus fundoplication for gastroesophageal reflux disease in patients with obesity results in comparable outcomes.

Autor: Joseph S; Department of Surgery, Wayne State University/Detroit Medical Center, Detroit, MI; Department of Surgery, NorthShore University Health System, Evanston, IL. Electronic address: sljoseph91@gmail.com., Vandruff VN; Department of Surgery, NorthShore University Health System, Evanston, IL; Department of Surgery, NorthShore University HealthSystem, University of Chicago Medical Center, Chicago, IL., Amundson JR; Department of Surgery, NorthShore University Health System, Evanston, IL; Department of Surgery, NorthShore University HealthSystem, University of Chicago Medical Center, Chicago, IL., Che S; Department of Surgery, NorthShore University Health System, Evanston, IL., Zimmermann C; Department of Surgery, NorthShore University Health System, Evanston, IL., Ishii S; Department of Surgery, NorthShore University Health System, Evanston, IL., Kuchta K; Department of Surgery, NorthShore University Health System, Evanston, IL., Denham W; Department of Surgery, NorthShore University Health System, Evanston, IL., Linn J; Department of Surgery, NorthShore University Health System, Evanston, IL., Hedberg HM; Department of Surgery, NorthShore University Health System, Evanston, IL., Ujiki MB; Department of Surgery, NorthShore University Health System, Evanston, IL.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2024 Mar; Vol. 175 (3), pp. 587-591. Date of Electronic Publication: 2023 Dec 27.
DOI: 10.1016/j.surg.2023.10.031
Abstrakt: Background: Roux-en-Y gastric bypass and fundoplication are effective treatments for gastroesophageal reflux disease, though the optimal procedure of choice in obesity is unknown. We hypothesize that Roux-en-Y gastric bypass is non-inferior to fundoplication for symptomatic control of gastroesophageal reflux disease in patients with obesity.
Methods: We conducted a retrospective review of a prospectively maintained quality database. Patients with a body mass index ≥of 35 who presented for gastroesophageal reflux disease and subsequently underwent Roux-en-Y gastric bypass or fundoplication were included. Perioperative outcomes and pH testing data were reviewed. Patient-reported outcomes included Reflux Symptom Index, Dysphagia, Gastroesophageal Reflux Disease-Health Related Quality of Life, and Short Form-36 scores. Data were analyzed using the Wilcoxon rank sum test.
Results: Ninety-five patients underwent fundoplication (n = 72, 75.8%) or Roux-en-Y gastric bypass (n = 23, 24.2%) during the study period. All patients saw an improvement in gastroesophageal reflux disease symptoms and overall quality of life. There were no significant differences in postoperative Reflux Symptom Index, Dysphagia, or Short-Form-36 scores. Significant differences in gastroesophageal reflux disease-Health Related Quality of Life scores were seen at preoperative, 1, 2, and 5 years postoperative (P < .05), with better symptom control in the fundoplication group. No significant difference was noted in postoperative DeMeester scores or percent time pH <4. Weight loss was significantly higher in the Roux-en-Y gastric bypass group at all postoperative time points up to 5 years (P < .05).
Conclusion: Roux-en-Y gastric bypass and fundoplication both decrease gastroesophageal reflux disease symptoms. Subjective data shows that patients undergoing Roux-en-Y gastric bypass may complain of worse symptoms compared to patients undergoing fundoplication. Objective data notes no significant difference in postoperative pH testing. Despite previous data, offering fundoplication or Roux-en-Y gastric bypass to patients with a body mass index of ≥35 kg/m 2 is appropriate. The choice of surgical approach should be more directed to patient needs and desired goals at the time of the initial clinic visit.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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