title: Does gastric banding for morbid obesity reduce or increase gastroesophageal reflux?
abstract: BACKGROUND
  Conflicting results regarding the influence of laparoscopic adjustable gastric banding (LAGB) on gastroesophageal reflux disease (GERD) have been published.
  
  
  METHODS
  A prospective follow-up study was conducted in 31 patients (male/female 5/26, mean age 44 +/- 11 SD years) with 24-hour pH and manometry recordings, symptom assessment, and upper GI endoscopy.
  
  
  RESULTS
  Total number of reflux episodes decreased from a mean value of 44.6 +/- 23.7 SD preoperatively to 22.9 +/- 17.1 postoperatively (P=0.0006), after a median follow-up time of 19 months (range 7-32 months). Total reflux time decreased from 9.5% +/- 6.2% to 3.5% +/- 3.7%, P=0.0009, and DeMeester score decreased from 38.5 +/- 24.9 to 18.6 +/- 20.4, P=0.03. Symptomatic patients decreased from 48.4% preoperatively to 16.1% postoperatively (P=0.01), medication for GERD decreased from 35.5% to 12.9% (P=0.05), and the diagnosis of GERD on 24-hour pH recordings decreased from 77.4% to 37.5% (P=0.01). There were no pouch enlargements seen on upper GI endoscopy. Esophageal motility was unchanged, but 36% of the patients had incomplete relaxation of the lower esophageal sphincter following the operation (P<0.0001). Mean BMI decreased from 46.0 +/- 5.46 to 38.4 +/- 6.45 (P<0.0001), excess weight from 60.0 kg +/- 18.58 kg, 44.9% +/- 6.56% to 38.4 kg +/- 20.27 kg, 28.4% +/- 10.97% (P<0.0001). No association between the postoperative diagnosis of GERD and the amount of weight loss could be found.
  
  
  CONCLUSIONS
  The correctly placed gastric band is an effective anti-reflux barrier in the short term. Long-term results have to be awaited.
authors.affiliation: Department of Gastrointestinal Surgery, Vasa Central Hospital, Vasa, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Tolonen
authors.forename: Mikael
authors.initials: M
authors.lastname: Victorzon
authors.forename: Risto
authors.initials: R
authors.lastname: Niemi
authors.forename: Jyrki
authors.initials: J
authors.lastname: Mäkelä
mesh_terms: D000328:Adult; D050782:Esophageal pH Monitoring; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000473:pathology / Q000517:prevention & control*; D015391:Gastroplasty; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome