# 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.

This notice describes how information about you may be used and disclosed and how you can gain access to this information.  Please review carefully

Contact Information: -Telephones: *** CLOS West: 702-456-4643; Trish Lanman 702-376-3446, Sandy Brubaker 702-376-3647; Jennifer Brubaker 702-376-9339, Dr. Rutledge 702-215-9550; 989-450-8081 Kim Hazen 989-450-8081 *** CLOS Florida: Flo Ballengee 863-899-3463 Wayne Robbins 704-682-1549 Elizabeth Robbins 704-928-6693 Dr. Cesare Peraglie 407-922-3424

Email Us Anytime for Help: Email: Dr. Rutledge DrR@clos.net, *** CLOS West: Trish Lanman Trish@clos.net, Sandy Brubaker SandyB@clos.net Dr. Rutledge DrR@clos.net, Kim Hazen khazen@clos.net *** CLOS Florida: Flo Ballengee flo@clos.net, Wayne Robbins wr@clos.net Elizabeth Robbins epr@clos.net Dr. Peraglie drp@clos.net

Addresses: Address: *** CLOS West Office: Dr Robert Rutledge / CELOS, 98 E Lake Mead Parkway Suite 302, Henderson NV 89015, Office 702-456-4643, Office fax: 702-456-1173, Contacts: Trish Lanman 702-376-3446 Trish@clos.net, Sandy Brubaker 702-376-3647 SandyB@clos.net, Jennifer Brubaker 702-376-9339 Jen@clos.net, Dr. Rutledge 702-215-9550 Drr@clos.net Kim Hazen 989-450-8081 khazen@clos.net *** CLOS Florida: 40124 Highway 27, Suite 203, Davenport, FL 33837, Wayne Robbins 704-682-1549, wr@clos.net, Elizabeth Robbins 704-928-6693 epr@clos.net, Dr. Peraglie 407-922-3424 drp@clos.net

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.  

Disclaimer Notice:-Information on this web site is provided for informational purposes only.
-It is imperative that you consult your own physician regarding the applicability of any opinions or recommendations with respect to your symptoms or medical condition.
-Contact with this web site or Dr. Rutledge over the web site does not constitute a doctor patient relationship and for good quality medical care you must obtain advice and consultation form your own local physician.
-This site is intended as a resource for references on the treatment of obesity for health care professionals and educated consumers.
-The authors and editors have used sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication.
-Medical knowledge changes rapidly. In view of the possibility of human error or changes in medical science, neither the authors nor the editors nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from the use of such information.
This information is not medical advice or diagnosis, nor is it to be construed as medical advice, medical information, medical diagnosis, or medical prescription for curing, removing, or preventing any disease, or related symptoms. You must seek the direct assistance, advice and evaluation of your own personal physician before acting on any information found herein. These statements have not been evaluated by the Food and Drug Administration.
-Readers are Strongly encouraged to discuss and confirm the information contained herein with your own physician.
Copyright © 1998 The Center for Laparoscopic Obesity Surgery