Journal article
Optimizing bariatric surgery outcomes: a novel preoperative protocol in a bariatric population with gastroesophageal reflux disease
Surgical endoscopy, Vol.34(4), pp.1812-1818
04/01/2020
DOI: 10.1007/s00464-019-06934-4
PMID: 31240476
Abstract
Background The Roux-en-Y gastric bypass (RYGB) isuery ID="Q1" Text="Author:Kindly check the edit made in the article title." -->the most efficacious procedure of choice for obese patients with gastroesophageal reflux disease (GERD). The laparoscopic sleeve gastrectomy (LSG) has high rates of worsening GERD post operatively. Little evidence exists as to whether the use of objective foregut investigations has a meaningful impact on surgical procedure selection. This study examined whether a standard preoperative foregut evaluation protocol effected procedure selection in bariatric patients presenting for surgical evaluation with subjective symptoms of GERD. Methods Patients presenting for bariatric surgery evaluation with subjective symptoms of GERD entered into a predetermined protocol of foregut evaluation. Patients initially underwent upper endoscopy and esophagram. If the patient desired a LSG, further testing with esophageal pH testing and high-resolution manometry was ordered. If significant pathology was discovered on any of these investigations RYGB was recommended, if investigations were normal LSG was felt to be permissible. Data were collected prospectively from July 2016 to December 2018 and reviewed. Results One hundred and thirty-three patients were identified as being eligible to have progressed through the protocol. Pathology was commonly discovered on preoperative evaluations. On EGD Barrett's esophagus was discovered in 4%, grade C or D esophagitis in 18% and hiatal hernia in 36% of patients. On esophagram, hiatal hernia was discovered in 42.3% of patients. Abnormal esophageal motility was discovered in 41% and abnormal DeMeester scores in 83% of tested patients. Of the 133 patients evaluated, the final procedure the patient ultimately underwent was primarily determined based on protocol test results in 24.8% of cases. Conclusions Foregut pathology is common in bariatric patients with subjective symptoms of GERD. Implementing a comprehensive protocol to objectively assess these patients leads to a significant clinical impact on which procedure these patients ultimately undergo.
Details
- Title: Subtitle
- Optimizing bariatric surgery outcomes: a novel preoperative protocol in a bariatric population with gastroesophageal reflux disease
- Creators
- Rhys Kavanagh - University of IowaJessica Smith - University of IowaUmair Bashir - University of IowaDana Jones - University of IowaEmily Avgenakis - University of IowaPeter Nau - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Surgical endoscopy, Vol.34(4), pp.1812-1818
- Publisher
- Springer Nature
- DOI
- 10.1007/s00464-019-06934-4
- PMID
- 31240476
- ISSN
- 0930-2794
- eISSN
- 1432-2218
- Number of pages
- 7
- Language
- English
- Date published
- 04/01/2020
- Academic Unit
- Surgery
- Record Identifier
- 9984322806902771
Metrics
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