Skip to main content
SpringerLink
Log in

Comparison of objective outcomes following laparoscopic Nissen fundoplication versus laparoscopic gastric bypass in the morbidly obese with heartburn

  • Original article
  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background: Heartburn and gastroesophageal reflux disease (GERD) affects approximately 25–50% of morbidly obese patients. Although objective physiologic testing has been reported extensively in patients following Nissen fundoplication, there are no previous reports of such testing in morbidly obese patients. A life-saving surgical alternative for the morbidly obese patient is gastric bypass surgery, which usually improves heartburn symptoms in addition to many serious health conditions such as diabetes, hypertension, and sleep apnea. We hypothesized that, in morbidly obese patients, gastric bypass surgery would be as effective as Nissen fundoplication in reducing both heartburn symptoms and esophageal acid exposure, as reflected by the DeMeester score. Methods: Between 1995 and 2000, all patients undergoing laparoscopic Nissen fundoplication (LN) and laparoscopic gastric bypass (LGB) in our practice underwent preoperative and postoperative esophageal physiologic testing. Patients were included in this study that were morbidly obese and had significant heartburn symptoms or objective evidence of acid reflux, and had repeat esophageal physiologic testing after either LN or LGB. Data were obtained through retrospective review of prospectively collected data. Results: Twelve patients met the inclusion criteria: six patients who had LN and six who had LGB. The mean body mass index (BMI) was 55 kg/m2 in the LGB group and 39.8 in the LN group. After surgery, the mean DeMeester score decreased from 64.3 to 2.8 in the LN group (p = 0.01) and from 34.7 to 5.7 in the LGB group (p = 0.1). Both groups’ mean postoperative DeMeester scores were normal after surgery, and there was no significant difference between the two groups (p = 0.3). Both groups experienced a significant improvement in heartburn symptoms postoperatively. The mean preoperative symptom score improved from 3.5 to 0.5 in the LN group (p = 0.01) and from 2.2 to 0.2 in the LGB group (p = 0.003). There was no difference in the mean postoperative symptom scores between the groups (p = 0.35). After surgery, mean LES resting pressures increased from 12.9 to 35.5 (p = 0.003) in the LN group and from 23.6 to 29.7 (p = 0.45) in the LGB group. There were no complications in either group. Conclusion: Results of this study show that laparoscopic gastric bypass and laparoscopic Nissen fundoplication are both effective in treating heartburn symptoms and objective acid reflux in morbidly obese patients. The health benefits of weight loss after laparoscopic gastric bypass should make this operation the procedure of choice in the morbidly obese patient with heartburn.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. BM Balsiger MM Murr J Mai MG Sarr (2000) ArticleTitleGastroesophageal reflux after intact vertical banded gastroplasty: correction by conversion to Roux-en-Y gastric bypass. J Gastrointest Surg 4 276–281 Occurrence Handle10.1016/S1091-255X(00)80076-1 Occurrence Handle1:STN:280:DC%2BD3czosFyjtA%3D%3D Occurrence Handle10769090

    Article  CAS  PubMed  Google Scholar 

  2. BL Fisher A Pennathur JL Mutnick AG Little (1999) ArticleTitleObesity correlates with gastroesophageal reflux. Dig Dis Sci 44 2290–2294 Occurrence Handle1:STN:280:DC%2BD3c%2FjvVSntQ%3D%3D Occurrence Handle10573376

    CAS  PubMed  Google Scholar 

  3. InstitutionalAuthorNameGastrointestinal surgery for severe obesity (1992) ArticleTitleNational Institutes of Health Consensus Development Conference Statement. Am J Clin Nutr 55 IssueID2 suppl 487S–619S

    Google Scholar 

  4. J Hagen M Deitel RK Khanna R Ilves (1987) ArticleTitleGastroesophageal reflux in the massively obese. Int Surg 72 1–3 Occurrence Handle1:STN:280:BiiB2cbltlI%3D Occurrence Handle3596968

    CAS  PubMed  Google Scholar 

  5. BW Jaffin P Knoepflmacher R Greenstein (1999) ArticleTitleHigh prevalence of asymptomatic esophageal motility disorders among morbidly obese patients. Obes Surg 9 390–395 Occurrence Handle1:STN:280:DyaK1Mvht1Whuw%3D%3D Occurrence Handle10484299

    CAS  PubMed  Google Scholar 

  6. KB Jones (1998) ArticleTitleRoux-en-Y gastric bypass: an effective antireflux procedure in the less than morbidly obese. Obes Surg 8 35–38 Occurrence Handle9562484

    PubMed  Google Scholar 

  7. L Lundell M Ruth N Sandberg M Bove-Nielsen (1995) ArticleTitleDoes massive obesity promote abnormal gastroesophageal reflux? Dig Dis Sci 40 1632–1635 Occurrence Handle1:STN:280:ByqA2sjgs1w%3D Occurrence Handle7648961

    CAS  PubMed  Google Scholar 

  8. WR Mercer SF Wren LR DaCosta IT Beck (1982) ArticleTitleGastroesophageal pressure gradients and lower esophageal sphincter pressure in severely obese patients. Gastroenterology 82 A1129

    Google Scholar 

  9. NT Nguyen HS Ho LS Palmer BM Wolfe (2000) ArticleTitleA comparison study of laparoscopic versus open gastric bypass for morbid obesity. J Am Coll Surg 191 149–155 Occurrence Handle10.1016/S1072-7515(00)00276-3 Occurrence Handle1:STN:280:DC%2BD3cvgvFKitw%3D%3D Occurrence Handle10945358

    Article  CAS  PubMed  Google Scholar 

  10. AR Perez AC Moncure DW Rattner (1999) ArticleTitleObesity is a major cause of failure for both abdominal and transthoracic antireflux operations. Gastroenterology 116 A1343

    Google Scholar 

  11. AR Perez AC Moncure DW Rattner (2001) ArticleTitleObesity adversely affects the outcome of antireflux operations. Surg Endosc 15 986–989 Occurrence Handle1:STN:280:DC%2BD3MrlvVCrtg%3D%3D Occurrence Handle11443428

    CAS  PubMed  Google Scholar 

  12. JH Peters TR DeMeester (1995) ArticleTitleIndications, principles of procedure selection, and technique of laparoscopic Nissen fundoplication. Surg 2 27–44

    Google Scholar 

  13. PR Schauer S Ikramuddin W Gourash R Ramanathan J Luketich (2000) ArticleTitleOutcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 232 515–529 Occurrence Handle10.1097/00000658-200010000-00007 Occurrence Handle1:STN:280:DC%2BD3M%2Fhs1eitA%3D%3D Occurrence Handle10998650

    Article  CAS  PubMed  Google Scholar 

  14. SC Smith CB Edwards GN Goodman (1997) ArticleTitleSymptomatic and clinical improvement in morbidly obese patients with gastroesophageal reflux disease following Roux-en-Y gastric bypass. Obes Surg 7 479–484 Occurrence Handle1:STN:280:DyaK1czpvVaksA%3D%3D Occurrence Handle9730504

    CAS  PubMed  Google Scholar 

  15. HJ Sugerman JM Kellum EJ DeMaria HD Reines (1996) ArticleTitleConversion of failed or complicated vertical banded gastroplasty to gastric bypass in morbid obesity. Am J Surg 171 263–269 Occurrence Handle10.1016/S0002-9610(97)89565-7 Occurrence Handle1:STN:280:BymC2sjhvFw%3D Occurrence Handle8619465

    Article  CAS  PubMed  Google Scholar 

  16. V Velanovich (2000) ArticleTitleQuality of life and severity of symptoms in gastroesophageal reflux disease: a clinical review. Eur J Surg 166 516–525 Occurrence Handle10.1080/110241500750008565 Occurrence Handle1:STN:280:DC%2BD3M7gvFarsA%3D%3D Occurrence Handle10965828

    Article  CAS  PubMed  Google Scholar 

  17. SA Wajed CG Streets CG Bremner TR DeMeester (2001) ArticleTitleElevated body mass disrupts the barrier to gastroesophageal reflux. Arch Surg 136 1014–1018 Occurrence Handle10.1001/archsurg.136.9.1014 Occurrence Handle1:STN:280:DC%2BD3MrislSjtA%3D%3D Occurrence Handle11529823

    Article  CAS  PubMed  Google Scholar 

  18. AC Wittgrove GW Clark (2000) ArticleTitleLaparoscopic gastric bypass, Roux-en-Y 500 patients: technique and results, with 3–60 month follow-up. Obes Surg 10 233–239 Occurrence Handle1:STN:280:DC%2BD3cvotFOlsQ%3D%3D Occurrence Handle10929154

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Minimally Invasive Surgery, Legacy Health System, 501 North Graham Street, Suite 120, Portland, OR 97227, USA

    E. J. Patterson, D. G. Davis, Y. Khajanchee & L. L. Swanström

Authors
  1. E. J. Patterson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. G. Davis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y. Khajanchee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. L. Swanström
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. J. Patterson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Patterson, E., Davis, D., Khajanchee, Y. et al. Comparison of objective outcomes following laparoscopic Nissen fundoplication versus laparoscopic gastric bypass in the morbidly obese with heartburn . Surg Endosc 17, 1561–1565 (2003). https://doi.org/10.1007/s00464-002-8955-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-002-8955-y

Keywords

Search

Navigation