title: The effect of concurrent esophageal pathology on bariatric surgical planning.
abstract: In the presence of esophageal pathology, there is risk of worse outcomes after laparoscopic adjustable gastric banding (LAGB) and sleeve gastrectomy (SG). This study reviewed how an esophageal workup affected a bariatric operative plan in patients with concurrent esophageal pathology. We retrospectively reviewed patients planning bariatric surgery referred with significant reflux, dysphagia, and hiatal hernia (>3 cm) to determine how and why a thorough esophageal workup changed a bariatric operative plan. We identified 79 patients for analysis from 2009 to 2013. In 10/41 patients (24.3%) planning LAGB and 5/9 patients planning SG (55.5%), a Roux was preferred because of severe symptoms of reflux and aspiration, dysphagia, manometric abnormalities (aperistaltic or hypoperistaltic esophagus with low mean wave amplitudes), large hiatal hernia (>5 cm), and/or presence of Barrett's esophagus. Patients without these characteristics had a decreased risk of foregut symptoms after surgery. We recommend a thorough esophageal workup in bariatric patients with known preoperative esophageal pathology. The operative plan might need to be changed to a Roux to prevent adverse outcomes including dysphagia, severe reflux, or suboptimal weight loss. An esophageal workup may improve surgical decision making and improve patient outcomes.
authors.affiliation: Division of Thoracic Surgery, Swedish Medical Center, Seattle, WA, USA.
authors.forename: Daniel Davila
authors.initials: DD
authors.lastname: Bradley
authors.forename: Brian E
authors.initials: BE
authors.lastname: Louie
authors.forename: Judy
authors.initials: J
authors.lastname: Chen
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Aye
authors.forename: Ross
authors.initials: R
authors.lastname: McMahon
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Farivar
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000379:methods*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis; D006551:Hernia, Hiatal / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome