Treatment of morbid obesity with laparoscopic adjustable gastric banding affects esophageal motility

BACKGROUND: Laparoscopic adjustable gastric banding has become the prefered method for the surgical treatment of morbid obesity in Europe; It is not k nown whether this procedure may induce gastroesophageal reflux and whether it may impair esophageal peristalsis. METHODS: Laparoscopic adjustable gastric banding (Swedish band) was perform ed in 43 patients (median body mass index [BMI] 42.5 kg/m(2)). Preoperative ly and 6 months postoperatively all patients were assessed for reflux sympt oms, In addition all patients underwent preoperative and postoperative endo scopy, esophageal barium studies and manometry, and 24-hour esophageal pH-m onitoring. RESULTS: The median BMI dropped significantly to 33.1 kg/m(2) (P <0.05). Pr eoperatively 12 patients complained of reflux symptoms. Mild esophagitis wa s detected in 10 patients. Postoperatively only 1 patient complained of hea rtburn and mild esophagitis was diagnosed in another patient. None of the p atients had dysphagia; Preoperatively a defective LES and pathologic pH-tes ting were found in 9 and 15 patients, respectively. These parameters were n ormal in all of the patients postoperatively. Postoperatively there was sig nificant impairment of LES relaxation and deterioration of esophageal peris talsis with dilatation of the esophagus in some of the patients. CONCLUSIONS: Laparoscopic adjustable gastric banding provides a sufficient antireflux barrier and therefore prevents pathologic gastroesophageal reflu x. However, it impairs relaxation of the LES, leading to weak esophageal pe ristalsis. (C) 2001 by Excerpta Medica, Inc.