Influencia de la cirugía bariátrica en los parámetros de manometría, pH-metria y vaciamiento isotópico en pacientes con obesidad mórbida.

by Escudero de Fez, Mª Dolores

ABSTRACT INTRODUCTION One of the co-morbidities frecuently associated with morbid obesity is gastroesophagela reflux disease (GERD). The objective of this study has been to compare the anti-reflux effect of vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGB), and their effect on esophageal function. PATIENTS AND METHOD A prospective non-randomized study on morbidly obese patients who underwent bariatric surgery. The patients were initially assigned alternately to two groups, according to the surgical operation performed: VBG and RYGB. Anthropometric parameters, symptomatology of GERD, esophageal manometry, 24- hr esophageal pH monitoring and isotopic esophageal emptying were recorded in all patients preoperatively, at 3 months and 1 year postoperatively. RESULTS 8 patients underwent VBG and 32 patients underwent RYGB. The mean age was 36.63 ± 7.6 years in VBG group and the 36.09 ± 7.57 years in RYGB group. 50% of the VBG patients suffered from heartburn preoperatively, was maintained at 3 months postoperatively, decreasing to 25% after 1 year. The patients with regurgitation was 25% preoperatively, the same at 3 months but zero at 1 year. Dysphagia was 25% preoperatively, 87.5% at 3 months and 75% continues with dysphagia at 1 year. 59.4% of the RYGB suffered of heartburn preoperatively, 6.3% at 3 months and 15.6% continues with heartburn at 1 year. Regurgitation was 43.8% preoperatively, 15.6% at 3 months and 9.4% at 1 year. Preoperatively dyspahagia was 18.8%, incrased to 43.8% at 3 months and was present at 34.4% of patients at 1 year after the operation. The percentage of patients with objetive reflux in 24- hour continuous esophageal monitoring in VBG group was 75% preoperatively, 25% at 3 months and 50% continues with reflux at 1 year postoperatively. In RYGB group 56.3% of patients was reflux preoperatively, 15.6% at 3 months, increasing to 21.9% of patients after 1 year. The values of manometry and isotopic emptying in both groups were within the normal range preoperatively, at 3 months and 1 year after surgery. CONCLUSIONS The patients with GBP have a significant relief of the reflux sintoms.There are not changes in manometric studies neither isotopic emptying in the patients with VBG and GBP.