Roux-en-Y Gastric Bypass: an Effective Antireflux Procedure in the Less Than Morbidly Obese

Background: Since Roux-en-Y gastric bypass (RYGBP) is an excellent antireflux procedure, why is it necessary to do it only for those who are morbidly obese: why not anyone who has had a longstanding severe weight problem with chronic disabling reflux esophagitis?

Methods: RYGBP was done primarily as an antireflux procedure in 332 patients late from 1987 through October 1996. Eighty-nine were less than 100 lb (45 kg) overweight. Forty-five were lost to follow-up. All but one had Visick ratings from 2 to 4 preoperatively. Thirty-one were primary RYGBP and 13 were conversions from previous gastroplasties. The diagnosis in each case was made by esophagogastroscopy with esophageal biopsy with or without the Bernstein test when indicated.

Results: Postoperatively, only one patient was symptomatic. The remaining had Visick ratings of 1. The average preoperative weight of 192 lb (87 kg) dropped to 145 lb (66 kg) postoperatively, or 67% of excess weight loss at a mean of 56 months. Compared to the morbidly obese group, there was no significant difference in 1-year postoperative laboratory values.

Conclusion: This study supports the efficacy and safety of RYGBP for reflux esophagitis in the less than morbidly obese patient. Esophagitis is truly a comorbid condition of severe obesity, and it should be accepted as such. The arbitrary elimination from the consideration of candidacy for this procedure by those with a body mass index of less than 35 kg/m2 and unproven comorbidity appears unjustified.