For obese patients with gastroesophageal reflux disease (GERD) that persists after standard surgery, relief may come from a type of “keyhole” operation that reduces the size of the stomach - laparoscopic gastric bypass - new research shows.

GERD is a common disease in which fluid from the stomach backs up into the esophagus, typically causing heartburn and other symptoms. In addition to drugs that reduce the secretion of this acidic fluid, GERD is treated with a type of surgery called fundoplication that tightens the junction between the esophagus and stomach.

The current findings, which appear in the journal Obesity Surgery, are based on a study of seven obese patients with persistent GERD after antireflux surgery who underwent laparoscopic gastric bypass.

“This study showed that all patients did well with zero mortality and were satisfied with their condition during the follow-up period, suggesting that the long-term outcome of laparoscopic gastric bypass in obese patients who had previous (fundoplication) is promising,” lead author Dr. Ioannis Raftopoulos said in a statement.

The alternative to undergoing gastric bypass in these patients would be to redo the fundoplication. However, Raftopoulos, an assistant professor of surgery at the University of Pittsburgh School of Medicine, noted that success rates for second operations are not especially high and, unlike gastric bypass, they do not produce weight loss.

Among the seven patients who underwent gastric bypass, complications within 30 days of the operation were relatively common, with two patients experiencing “leaks” from where their intestine was sewn together and one patient had a blood clot travel to the lungs.

After being followed for 2 years, the participants in the study lost an average of 71 percent of their excess weight, the authors point out. Moreover, 14 of 20 other medical problems seen in the study group improved or resolved.

In particular, there was a dramatic improvement in GERD.

SOURCE: Obesity Surgery, November 2004.