A recent study points to the effectiveness of a special combination of surgery for reflux patients who are also morbidly obese.Doctors Ionnis Raftopoulos and colleagues from the University of Pittsburgh Medical Center ran the study, which involved 7 morbidly obese patients, all of whom had already had surgery to correct acid reflux, and then underwent gastric bypass surgery which incorporated the reflux surgery’s changes into the new surgery, for combined combat of both reflux and obesity.
All seven patients survived the surgery, though there were three major complications and all patients experienced some form of complication, as is common with most gastric bypass surgeries. At an average post-operative check-in time of 24 months, the average amount of excess weight lost by the patients was over 70%, and 70% of associated (i.e. “co-morbid”) conditions were improved or resolved completely.
Raftopoulos and his team were pleased with the results of the study. Raftopoulos and colleagues wrote, “it is feasible and effective for the treatment of recurrent GERD and worsening obesity with the additional advantage of weight loss and improvement of co-morbidities.” The full results of the study were published in the November/December issue of the journal Obesity Surgery.
The surgery used in the study was a particular type of bypass surgery known as laparoscopic Roux-en-Y surgery (LRYGBP). As the name shows, the surgery is laparoscopic in nature. This means that the surgery is completed with the use of a laparoscope – a tiny, telescope-like instrument that can be inserted into areas in the body to aid doctors’ ability to see inside.
A plus of laparoscopic methods is that if doctors do not need to cut into the body to get a view of the structures inside, they can often perform surgical tasks through tiny incisions, with small, specially designed instruments. This helps to minimize the invasiveness of the procedure (the extent to which the body is “opened up”), thereby cutting down on trauma to the body and often drastically reducing recovery time. Also, the surgery is far less likely to leave unsightly scars on the body, because it involves only very small cuts, which close quickly and easily.
Gastric bypass surgery acts to prevent the digestion of more than small amounts of good at a time by surgically resizing the stomach so that it can literally fit less food, as well as bypassing part of the small intestine to prevent the absorption of calories, which is the part of the surgery that accounts for its name. Of course, the problem with bypassing the digestive tract is that not only calories, but also essential vitamins, minerals, and nutrients, cannot be absorbed by the body either. Roux-en-Y surgery, though still subject to concerns regarding digestion and nutrition problems, bypasses less of the small intestine, thereby making it easier for patients to absorb needed nutrition while still digesting fewer calories per meal.
The resizing of the stomach can make the stomach smaller in two ways: by either stapling, as in Roux-en-Y surgery and two other techniques called biliopancreatic diversion and duodenal switch bypass, or by using specially a designed device called a gastric silastic ring to close off a section of the stomach, rather than staples.
One drawback of the laparoscopic procedure is that the surgery is difficult to perform. It has a very steep learning curve due to the large amount of technical skill and laparoscopic training required to learn the procedure. This translates to longer surgery times of six or more hours, compared with two or three for open gastric bypass surgery.
Also, as the doctors who conducted the study note, bypass surgery is associated with many risks and complications, which may include death. It is a procedure only to be used as a last-ditch effort in fighting life-threatening obesity, and requires extreme modification of lifestyle and diet to remain effective in the long term.
