Prevalent esophageal body motility disorders underlie aggravation of GERD symptoms in morbidly obese patients following adjustable gastric banding.
OBJECTIVE
Preexisting gastroesophageal reflux disease (GERD) and esophageal motility disorders may affect the outcome of laparoscopic adjustable gastric banding (AGB).


METHODS
Prospective cohort study.


METHODS
Tertiary referral center.


METHODS
Between January 1, 1996, and December 31, 2002, AGB procedures were performed in 587 patients (mean body mass index, 46.7 [calculated as weight in kilograms divided by the square of height in meters]). The study population was composed of patients with preoperative GERD (assessed by a symptom-score questionnaire) and was divided into group 1 (those with preoperative GERD symptoms only) and group 2 (those with preoperative and postoperative GERD symptoms).


METHODS
Laparoscopic AGB was performed according to the pars-flaccida technique.


METHODS
All patients underwent preoperative and annual postoperative symptom scoring, endoscopy, esophageal barium swallow tests, esophageal manometry, and 24-hour pH monitoring.


RESULTS
Mean follow-up time was 33 months (range, 12-49 months). A total of 164 patients (27.9%) were diagnosed as having preoperative GERD symptoms. In 112 (68.3%) of these patients GERD symptoms vanished postoperatively (group 1), whereas 52 patients (31.7%) remained symptomatic after undergoing laparoscopic AGB implantation (group 2). Preoperatively, group 2 patients showed significantly poorer esophageal body motility compared with group 1 patients (20.8% vs 12.8% defective propagations; P = .007). In group 2 the mean symptom scores for dysphagia (0.4 vs 0.9) and regurgitation (0.6 vs 1.4) deteriorated significantly following laparoscopic AGB implantation, respectively. Eighteen patients (34.6%) in group 2 developed esophageal dilatation.


CONCLUSIONS
Adjustable gastric banding provides a sufficient antireflux barrier in most of the obese patients with GERD. However, in patients with preoperatively defective esophageal body motility, AGB may aggravate GERD symptoms and esophageal dilatation. Alternative bariatric surgical procedures should be considered in these patients.
Department of General and Transplant Surgery and Radiology, Medical University Innsbruck, Innsbruck, Austria.
Alexander
A
Klaus
Ingrid
I
Gruber
Gerold
G
Wetscher
Hermann
H
Nehoda
Franz
F
Aigner
Regina
R
Peer
Raimund
R
Margreiter
Helmut
H
Weiss
D000328:Adult; D015154:Esophageal Motility Disorders / Q000453:epidemiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology*; D015391:Gastroplasty; D005773:Gastroscopy; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology* / Q000601:surgery; D011184:Postoperative Period; D011446:Prospective Studies