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Alexander Klaus, MD; Ingrid Gruber, MD; Gerold Wetscher, MD; Hermann Nehoda, MD; Franz Aigner, MD; Regina Peer, MD; Raimund Margreiter, MD; Helmut Weiss, MD

Arch Surg. 2006;141:247-251.

Hypothesis  Preexisting gastroesophageal reflux disease (GERD) and esophageal motility disorders may affect the outcome of laparoscopic adjustable gastric banding (AGB).

Design  Prospective cohort study.

Setting  Tertiary referral center.

Patients  Between January 1, 1996, and December 31, 2002, AGB procedures were performed in 587 patients (mean body mass index, 46.7 [calculated as weight in kilograms divided by the square of height in meters]). The study population was composed of patients with preoperative GERD (assessed by a symptom-score questionnaire) and was divided into group 1 (those with preoperative GERD symptoms only) and group 2 (those with preoperative and postoperative GERD symptoms).

Interventions  Laparoscopic AGB was performed according to the pars-flaccida technique.

Main Outcome Measures  All patients underwent preoperative and annual postoperative symptom scoring, endoscopy, esophageal barium swallow tests, esophageal manometry, and 24-hour pH monitoring.

Results  Mean follow-up time was 33 months (range, 12-49 months). A total of 164 patients (27.9%) were diagnosed as having preoperative GERD symptoms. In 112 (68.3%) of these patients GERD symptoms vanished postoperatively (group 1), whereas 52 patients (31.7%) remained symptomatic after undergoing laparoscopic AGB implantation (group 2). Preoperatively, group 2 patients showed significantly poorer esophageal body motility compared with group 1 patients (20.8% vs 12.8% defective propagations; P = .007). In group 2 the mean symptom scores for dysphagia (0.4 vs 0.9) and regurgitation (0.6 vs 1.4) deteriorated significantly following laparoscopic AGB implantation, respectively. Eighteen patients (34.6%) in group 2 developed esophageal dilatation.

Conclusions  Adjustable gastric banding provides a sufficient antireflux barrier in most of the obese patients with GERD. However, in patients with preoperatively defective esophageal body motility, AGB may aggravate GERD symptoms and esophageal dilatation. Alternative bariatric surgical procedures should be considered in these patients.

Author Affiliations: Departments of General and Transplant Surgery (Drs Klaus, Gruber, Wetscher, Nehoda, Aigner, Margreiter, and Weiss) and Radiology (Dr Peer), Medical University Innsbruck, Innsbruck, Austria.

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