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. 2022 Jan 5;34(3):e1614.
doi: 10.1590/0102-672020210002e1614. eCollection 2022.

ANTI-REFLUX PROCEDURES AFTER ROUX-EN-Y GASTRIC BYPASS

[Article in English, Portuguese]
David Motola  1 , Ibrahim M Zeini  1 , Rena C Moon  1 , Muhammad Ghanem  1 , Andre F Teixeira  1 , Muhammad A Jawad  1
Affiliations

ANTI-REFLUX PROCEDURES AFTER ROUX-EN-Y GASTRIC BYPASS

[Article in English, Portuguese]
David Motola et al. Arq Bras Cir Dig. .

Abstract
in English, Portuguese

Background: Roux-en-Y gastric bypass (RYGB) has been the choice of bariatric procedure for patients with symptomatic reflux - and is known to be effective in reducing the need for anti-reflux medication postoperatively. However, a small number of RYGB patients can still develop severe reflux symptoms that require a surgical intervention.

Aim: To examine and describe the patient population that requires an anti-reflux procedure after RYGB evaluating demographics, characteristics, symptoms and diagnosis.

Methods: A retrospective chart review was performed on 32 patients who underwent a hiatal hernia repair and/or Nissen fundoplication after RYGB Jul 1st, 2014 and Dec 31st, 2019. Patients were identified using the MBSAQIP database and their electronic medical records were reviewed.

Results: Most patients were female (n=29, 90.6%). The mean age was 52.8 years and the mean body mass index (BMI) was 34.1 kg/m2 at the time of anti-reflux procedure. Patients underwent the anti-reflux procedure at a mean of 7.9 years after the RYGB procedure. The mean percentage of excess BMI loss during the time between RYGB and anti-reflux procedure was 63.4%.

Conclusions: Female patients with a significant weight loss may develop a severe reflux symptoms years after RYGB. Complaints of reflux after RYGB should not be overlooked. Careful follow-up and appropriate treatment (including surgical intervention) is needed for this population.

Racional:: O bypass gástrico em Y-de-Roux (RYGB) tem sido o procedimento bariátrico de escolha para pacientes com refluxo sintomático - e é conhecido por ser eficaz na redução da necessidade de medicação anti-refluxo no pós-operatório. No entanto, um pequeno número de pacientes com RYGB ainda pode desenvolver sintomas de refluxo graves que requerem uma intervenção cirúrgica.

Objetivo:: Examinar e descrever a população de pacientes que requer procedimento anti-refluxo após RYGB avaliando dados demográficos, características, sintomas e diagnóstico.

Métodos:: Revisão retrospectiva de prontuários foi realizada em 32 pacientes submetidos a hérnia hiatal e / ou fundoplicatura Nissen após RYGB em 1º de julho de 2014 a 31 de dezembro de 2019. Os pacientes foram identificados por meio do banco de dados MBSAQIP e seus prontuários eletrônicos foram revisados.

Resultados:: A maioria dos pacientes era do sexo feminino (n = 29 - 90,6%). A média de idade foi de 52,8 anos e o índice de massa corporea (IMC) médio de 34,1 kg / m2 na época do procedimento anti-refluxo. Os pacientes foram submetidos ao procedimento anti-refluxo em média 7,9 anos após o procedimento do BGYR. A porcentagem média de perda do excesso de IMC durante o tempo entre o BGYR e o procedimento anti-refluxo foi de 63,4%.

Conclusões:: Pacientes do sexo feminino com perda de peso significativa podem desenvolver sintomas graves de refluxo anos após o BGYR. Sintomas de refluxo após RYGB não devem ser negligenciadas. Acompanhamento cuidadoso e tratamento adequado (incluindo intervenção cirúrgica) são necessários para essa população.

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Conflict of interest statement

Conflict of interest: David Motola, Ibrahim M. Zeini, Rena C. Moon, and Muhammad Ghanem have no conflicts of interest or financial ties to disclose. Andre F. Teixeira is a consultant for Intuitive Surgical and Ethicon Endo-surgery. Muhammad A. Jawad is a consultant for Ethicon Endo-surgery.

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