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Al-Khyatt et al. Mini-invasive Surg 2018;2:3 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2017.49

Original Article Open Access

Upper gastrointestinal surgeon attitudes towards
management of refractory gastroesophageal reflux
disease in obese patients

Waleed Al-Khyatt, Sherif Awad, Paul Leeder

The East-Midlands Bariatric & Metabolic Institute, Royal Derby Hospital, Derby DE22 3NE, UK.

Correspondence to: Dr. Waleed Al-Khyatt, The East-Midlands Bariatric & Metabolic Institute, Royal Derby Hospital, Uttoxeter Road,
Derby DE22 3NE, UK. E-mail: walkhyatt@yahoo.com

How to cite this article: Al-Khyatt W, Awad S, Leeder P. Upper gastrointestinal surgeon attitudes towards management of refractory
gastroesophageal reflux disease in obese patients. Mini-invasive Surg 2018;2:3. http://dx.doi.org/10.20517/2574-1225.2017.49

Received: 6 Dec 2017 First Decision: 26 Jan 2018 Revised: 26 Feb 2018 Accepted: 27 Feb 2018 Published: 28 Feb 2018
Science Editor: Charles F. Bellows Copy Editor: Jun-Yao Li Production Editor: Huan-Liang Wu

Abstract
Aim: The marked increase in prevalence of obesity has been associated with an increase in obese patients seeking surgical
treatment for refractory gastroesophageal reflux disease (GORD). The management of GORD in such patients remains
contentious with no published guidelines.

Methods: A snapshot 9-item online survey was undertaken to elicit professional opinions of UK surgeons regarding the
surgical management of refractory GORD in obese patients.

Results: Eighty-two percent and 51% of surgeons performed more than 10 anti-reflux procedures and more than 10
bariatric procedures per year, respectively. Nearly 80 of responders would consider laparoscopic fundoplication as the
2
preferred option for management of refractory GORD in patients with body mass index (BMI) of 30-34.9 kg/m . In
contrast, 58% and 80% would discuss bariatric surgery as an alternative treatment option for refractory GORD in patients
2
with BMI 35-39.9 and ≥ 40 kg/m , respectively. Moreover, a bariatric procedure was considered the preferred option
2
by 74% of respondents for patients with BMI ≥ 40 kg/m with refractory GORD, and by 58% for BMI ≥ 35 patients with
refractory GORD and significant comorbidities. Eighty percent of surgeons agreed that laparoscopic Roux en-Y gastric
bypass (LRYGB) was the preferred bariatric procedure for the management of obese patients with documented GORD.

Conclusion: Our survey demonstrated that amongst UK upper gastrointestinal surgeons, bariatric surgery, specifically
2
LRYGB, was a preferred option for management of patients with a BMI ≥ 35 kg/m and refractory GORD. Updated national
guidelines are necessary to inform consensus on the management of GORD in obese patients.

Keywords: Obesity, morbid, bariatric, surgery, gastrooesophageal, reflux

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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