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Al-Khyatt et al. Mini-invasive Surg 2018;2:3 I http://dx.doi.org/10.20517/2574-1225.2017.49 Page 3 of 5

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Figure 1. Summary of UK upper gastrointestinal surgeon attitudes towards management of refractory gastroesophageal reflux disease
in obese patients. BMI: body mass index; GORD: gastroesophageal reflux disease; LSG: laparoscopic sleeve gastrectomy; LRYGB:
laparoscopic Roux en-Y gastric bypass; LMGB: laparoscopic mini gastric bypass

majority of surgeons would consider a bariatric procedure the preferred option for management of refractory
GORD in the morbidly obese and would discuss this as an option with their patients. The majority of
respondents felt that LRYGB was the best option to treat medically refractory GORD in this patient group.

Anti-reflux surgery is recognised as the treatment option of choice for medically refractory GORD [24-26] .
[27]
However, patient selection is essential to achieving a good outcome . To date, few studies have examined
the long-term efficacy and durability of traditional anti-reflux procedures such as Nissen fundoplication in
the setting of severe obesity, and results have been conflicting [18-22] . It has been suggested that laparoscopic
anti-reflux surgery is associated with a higher failure rate in obese patients because of intraoperative
[28]
technical difficulties as well as increased intra-abdominal pressure postoperatively . Nevertheless, others
[17]
have reported equivalent outcomes in obese and normal weight individuals . Obesity and GORD have
a well-defined association due to several anatomic and hormonal pathophysiologic mechanisms [7-16] .
Ultimately, while the medical and surgical treatment of GORD is advancing, there is a relative lack of
specific studies examining novel GORD treatments in obese patients.

Existing data demonstrate LRYGB to be associated with significant improvement in GORD symptoms [26,27,29] .
Many morbidly obese patients with GORD also suffer additional obesity-related conditions that are