title: Laparoscopic Nissen fundoplication with gastric plication as a potential treatment of morbidly obese patients with GERD, first experience and results.
abstract: BACKGROUND
  Laparoscopic Nissen fundoplication is an effective treatment for gastroesophageal reflux disease (GERD). However, there is no consensus for the surgical treatment of GERD in morbidly obese patients.
  
  
  METHODS
  Twenty-five morbidly obese patients with GERD underwent our novel procedure, laparoscopic Nissen fundoplication with gastric plication (LNFGP), and were monitored for 6 to 18 months. Operative complication, weight loss, and GERD symptoms were monitored.
  
  
  RESULTS
  The study subjects consisted seven males and 18 females. The average age was 38.2 years (from 18 to 58), and the mean BMI was 37.9 kg/m(2) (from 31.5 to 56.4). The mean operative time was 145.6 min (from 105 to 190). All procedures were performed via laparoscopic surgery. Two patients (8%) displayed a major 30-day perioperative complication. The first patient had an acute leak on the second postoperative day. The patient received a laparoscopic revision sleeve gastrectomy and was discharged 5 days later after an uneventful recovery. Another patient developed an intra-abdominal abscess 3 weeks after surgery and received laparoscopic drainage and a revision sleeve gastrectomy. Upon follow-up, only four (16%) patients experienced occasional acid regurgitation symptoms; however, no anti-acid medication was required. A significant decrease in the prevalence of erosive esophagitis (80 vs. 17%) after LNFGP was observed. The mean weight loss was 9.7, 14.1, 17.9, and 18.1% at 1, 3, 6 and 12 months, respectively. The mean BMI decreased to 30.8 kg/m(2) 1 year post surgery with a mean body weight loss of 25 kg.
  
  
  CONCLUSIONS
  LNFGP appears to be an acceptable treatment option for treating GERD in morbidly obese patients who refuse Roux-en-Y gastric bypass. However, further study is indicated to verify this novel procedure.
authors.affiliation: From the Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Taoyuan, Taiwan, wjlee_obessurg_tw@yahoo.com.tw.
authors.forename: Wei-Jei
authors.initials: WJ
authors.lastname: Lee
authors.forename: Ming-Lun
authors.initials: ML
authors.lastname: Han
authors.forename: Kong-Han
authors.initials: KH
authors.lastname: Ser
authors.forename: Ju-Juin
authors.initials: JJ
authors.lastname: Tsou
authors.forename: Jung-Chien
authors.initials: JC
authors.lastname: Chen
authors.forename: Chia-Hsien
authors.initials: CH
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult