Original article
Laparoscopic fundoplication compared with laparoscopic gastric bypass in morbidly obese patients with gastroesophageal reflux disease

This study was presented at the 25th Annual Meeting of the American Society for Metabolic and Bariatric Surgery Poster Session, Washington DC, June 18, 2008
https://doi.org/10.1016/j.soard.2008.08.021Get rights and content

Abstract

Background

Gastroesophageal reflux disease (GERD) is commonly associated with morbid obesity. Laparoscopic fundoplication is a standard surgical treatment for GERD, and laparoscopic gastric bypass has been shown to effectively resolve GERD symptoms in the morbidly obese. We sought to compare the in-hospital outcomes of morbidly obese patients who underwent laparoscopic fundoplication for the treatment of GERD versus laparoscopic gastric bypass for the treatment of morbid obesity and related conditions, including GERD, at U.S. academic medical centers.

Methods

Using the “International Classification of Diseases, 9th Revision” procedural and diagnoses codes for morbidly obese patients with GERD, we obtained data from the University HealthSystem Consortium database for all patients who underwent laparoscopic fundoplication or laparoscopic gastric bypass from October 2004 to December 2007 (n = 27,264). The outcome measures included the patient demographics, length of stay, in-hospital overall complications, mortality, risk-adjusted mortality ratio (observed to expected mortality), and hospital costs.

Results

Compared with the patients who underwent laparoscopic gastric bypass, those who underwent laparoscopic fundoplication had a lower severity of illness score (P <.05). The overall in-hospital complications were significantly lower in the laparoscopic gastric bypass group (P <.05). The mean length of stay, observed mortality, risk-adjusted mortality, and hospital costs were comparable between the 2 treatment groups.

Conclusion

Laparoscopic gastric bypass is as safe as laparoscopic fundoplication for the treatment of GERD in the morbidly obese. Hence, morbidly obese patients with GERD should be referred for bariatric surgery evaluation and offered laparoscopic gastric bypass as a surgical option.

Section snippets

Methods

The University HealthSystem Consortium (UHC) database is an administrative, clinical, and financial database that provides benchmark measures on the use of healthcare resources for the purpose of comparative data analysis. The UHC is an alliance of 101 academic medical centers and 178 of their affiliated hospitals, representing approximately 90% of the nation's nonprofit academic medical centers. The UHC database is a collection of patient-level, discharge-abstracted data from academic health

Results

During the study period, 27,264 morbidly obese patients with GERD underwent either laparoscopic fundoplication (n = 6108) or laparoscopic gastric bypass (n = 21,156) at U.S. academic medical centers. The proportion of women who had undergone laparoscopic gastric bypass was significantly greater than the proportion who had undergone laparoscopic fundoplication (P <.05; Table 1). The proportion of whites was significantly greater, followed by blacks and Hispanics (P <.05). Morbidly obese black

Discussion

The present study analyzed and compared the perioperative safety and other outcomes of 2 different groups of morbidly obese individuals with GERD who had undergone either laparoscopic fundoplication for the treatment of GERD or laparoscopic gastric bypass for the treatment of obesity-related conditions, including GERD. The main finding of the present study was that laparoscopic gastric bypass is as safe as laparoscopic fundoplication for the treatment of GERD and morbid obesity. However,

Conclusion

Within the context of U.S. academic medical centers, the proportion of morbidly obese patients with GERD who underwent laparoscopic fundoplication procedures was low but resulted in significantly greater in-hospital complications. Whether morbidly obese patients with GERD undergo laparoscopic fundoplication for treatment of GERD or laparoscopic gastric bypass for treatment of morbid obesity, the perioperative outcomes of the latter appeared to be superior in terms of perioperative morbidity. A

Disclosures

The authors and the University HealthSystem Consortium database have no conflicts of interests; Dr. Varela has been a consultant for Ethicon, and Dr. Nguyen has been a consultant for Ethicon and Covidien.

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    Copyright © 2009 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.