VERTICAL BANDED GASTROPLASTY OR GASTRIC BANDING FOR MORBID-OBESITY - EFFECTS ON GASTROESOPHAGEAL REFLUX

Objective: To assess the effect of vertical banded gastroplasty and ga stric banding on the development of gastro-oesophageal reflux using bo th subjective and objective methods. Design: Prospective, randomised s tudy. Setting: Teaching hospital, Sweden. Subjects: 50 consecutive, mo rbidly obese patients (mean (SD) body mass index (BMI) 42.5 (5), 27 wo men and 23 men; mean age 48 years, range 38-57 years). Interventions: Vertical banded gastroplasty (n = 24) or gastric banding (n = 26). Mai n outcome measures: Results of evaluation by standardised questionnair e, 24-hour ambulatory pH-metry, and endoscopy. Results: After six mont hs the mean (SD) BMI had decreased to 34.4 (5.7), with no differences between the groups. Mild dysphagia was somewhat more common (13 compar ed with 1) but the incidence of heartburn (8 compared with 17), and ac id regurgitation (12 compared with 14) were less after the operation; 3 patients developed erosive oesophagitis, two in the vertical banded group and one in the banding group. Ambulatory pH-metry readings did n ot change significantly from preoperatively and there were no differen ces between the two operations. One patient developed pathological ref lux, and in three the values returned to the normal range. Conclusion: Gastric restriction operations including those with a narrow stoma th at causes outflow obstruction do not seem to increase the incidence of reflux in patients with functioning antireflux barriers.