Incidence of regurgitation after the banded gastric bypass.
BACKGROUND
Frequent regurgitation is a common complication following Roux-en-Y gastric bypass (RYGBP). This study investigated the risk of becoming a chronic regurgitator, by considering silicone ring size and lower esophageal sphincter (LES) function, and their relationship with weight loss.


METHODS
80 morbidly obese patients were randomly selected to undergo surgery using ring length of 62 mm (40 patients, group A) or 77 mm (40 patients, group B), with 6 months' postoperative follow-up. Preoperative esophageal manometry parameters were correlated with occurrence of chronic postoperative regurgitation. Patients were considered to present chronic regurgitation when this occurred on >10 days/month.


RESULTS
The groups were homogeneous regarding age, gender, race, weight, BMI (47.8+/-6.1 vs 50.2+/-6.4 kg/m2) and obesity-related diseases. There were 15% more chronic regurgitators in group A than in group B. Chronic regurgitators in group A lost more weight than chronic regurgitators in group B (P=0.026) or non-chronic regurgitators in group A (P=0.016). A greater proportion of chronic regurgitators had LES hypotonia (mean respiratory pressure <14 mmHg) than did non-chronic regurgitators (P=0.008). Logistic regression demonstrated that the chance of being a chronic regurgitator in group A was 4.5 times greater than in group B (P=0.046), and that the chance of a chronic regurgitator having LES hypotonia was seven times greater than of having normal LES pressure (P=0.006).


CONCLUSIONS
Silicone ring size and LES hypotonia are independent prognostic factors for chronic regurgitation following RYGBP. Ring size and chronic regurgitation contribute significantly towards weight loss during the first 6 postoperative months.
Arasaki
Carlos Haruo
CH
Department of Surgery, Federal University of São Paulo, Escola Paulista de Medicina, São Paulo, Brazil. haruo@osite.com.br
Del Grande
José Carlos
JC
Yanagita
Edison Takehiko
ET
Alves
Ana Karina Soares
AK
Oliveira
Daniel Riccioppo C F
DR
D000328:Adult; D002908:Chronic Disease; D004867:Equipment Design; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects*; D015391:Gastroplasty / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D015994:Incidence; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies; D012828:Silicones; D016037:Single-Blind Method; D016896:Treatment Outcome; D014839:Vomiting / Q000453:epidemiology / Q000209:etiology*; D015431:Weight Loss
D012828:Silicones