title: Gastroesophageal reflux after vertical banded gastroplasty is alleviated by conversion to gastric bypass.
abstract: BACKGROUND
  Conversion operations after vertical banded gastroplasty (VBG) are sometimes performed because of vomiting and/or acid regurgitation. Primary operation with gastric bypass (GBP) is known to reduce gastroesophageal reflux (GERD). Previous studies have not been designed to differentiate between the effects of the altered anatomy and of the ensuing weight loss. No series has reported data on acid reflux before and after conversion from VBG to GBP.
  
  
  METHODS
  We invited eight VBG patients with current symptoms of GERD. All had intact staple lines as assessed by barium meal and gastroscopy. Acid reflux was quantified using 48-h Bravo capsule measurements. Conversion operations were performed creating an isolated 15-20-ml pouch; the previously banded part of gastric wall was excised. Gastrojejunostomy was made end to end with a 28-mm circular stapler. The study is based on five patients consenting to early postoperative endoscopy and pH measurement.
  
  
  RESULTS
  All patients were women with a mean age of 49.5 years and BMI of 36.3. Time since VBG was 132.1 months. Time from conversion to second measurement was 46.6 days and BMI at that time 32.7. There was no mortality and no serious morbidity. All patients improved clinically and no patient had to go back on proton pump inhibition or antacids. Total time with pH < 4.0 was reduced from 18.4% to 3.3% (p < 0.05). DeMeester score was reduced from 58.1 to 15.9 (p < 0.05).
  
  
  CONCLUSIONS
  The effect of converting VBG-operated patients to GBP results in a near-normalisation of acid reflux parameters and a discontinuation of proton pump inhibitor medication.
authors: Department of Surgery, Clinical Sciences, Lund University, 221 85, Lund, Sweden.
authors: M
authors: M
authors: Ekelund
authors: S
authors: S
authors: Oberg
authors: R
authors: R
authors: Peterli
authors: S G
authors: SG
authors: Frederiksen
authors: J L
authors: JL
authors: Hedenbro
mesh_terms: D000328:Adult; D001466:Barium Sulfate; D003287:Contrast Media; D005260:Female; D015390:Gastric Bypass; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D054328:Proton Pump Inhibitors; D011859:Radiography; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D054328:Proton Pump Inhibitors; D001466:Barium Sulfate