2012, Number 1
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ABSTRACTObjective: To provide a preliminary report on a new surgical approach in patients with indication for surgery to treat gastroesophageal reflux disease (GERD) and simultaneous morbid obesity (MO).
Setting: Hospital Beneficencia Española de la Laguna.
Design: Pilot study.
Statistical analysis: Percentage as summary measure for qualitative variables.
Material and methods: We report five patients with GERD and MO subjected to laparoscopic Nissen fundoplication (LNF) and greater curvature gastroplication (GCGP) simultaneously. Inclusion criteria were patients with indications for GERD and MO surgery according to the Official Mexican Norm for Bariatric Surgery; all patients were evaluated by a multidisciplinary team. Analyzed variables were age, gender, surgical time, in-hospital stay, immediate post-surgical symptoms and at six months, aside from endoscopic control and esophagus-gastroduodenal series, as well as weight loss.
Results: Three women and two men with a body mass index of 39.5 and 45.2. Average surgical time was of 90 min, they were all subjected to transoperative endoscopy to assess adequacy and competence of the procedures. In-hospital stay was of 24 h, most patients coursed with nausea of easy control; before discharge they were subjected to esophagus-gastroduodenal series to corroborate the state of the surgery. Follow up was for at least six months, during this time they were subjected to endoscopy and esophagus-gastroduodenal series, revealing competent fundoplications and no changes in the size of the gastroplication. Loss of excess weight was of 38% and a good reflux control was attained. No complications have arisen as of yet.
Conclusions: The LNF is the procedure established for the surgical control of GERD. Gastroplication is emerging as a satisfactory procedure in bariatric surgery. In the present report, the combined use of these procedures demonstrated to be feasible, safe, with a good reflux control, acceptable morbidity and mortality and satisfactory weight loss. However, be believe that a larger number of cases in prospective and randomized studies is needed to establish the definite place of this promising combination of procedures.
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