GASTROESOPHAGEAL SYMPTOMS AFTER LAPAROSCOPIC GASTRIC BYPASS: MISTAKES IN PERFORMING THE PROCEDURE?

Abstract

Walter de Biase SILVA-NETO1, Claudemiro QUIRESE1, Eduardo GuiABSTRACT – BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LGB) is the recommended procedure for morbidly obese patients with gastroesophageal reflux disease (GERD). However, there Fabriciohave beenFerreirareported COELHOgastroesophageal3, Pauloreflux symptomsHERMANor esophagitis3 after LGB. Few functional esophageal studies have been reported to date. AIM: To evaluate the anatomic and physiologic factors contributing to the appearance of these problems in patients who underwent LGB. METHODS: This prospective study included 38 patients with postoperative gastroesophageal RESUMOreflux symptoms-Racional:submittedO tratamentoto LGB. deTheyescolhawere subjectedpara pacientesto clinical,comendoscopic,hipertensãoradiologic,portal esquistossomóticamanometric, and 24-hcompH-monitoringsangramentoevaluations.de varizesRESULTS:é a desconexãoEighteen (47.4%)ázigo-portalof 38 patientsmais esplenectomiapresented with (DAPE)heartburnassociadaor regurgitation,à terapia7 presentedendoscópica.withPorém,pain, andestudos4 presentedmostramwith aumentodysphagia. doErosivecalibreesophagitisdas varizeswasemobservedalguns pacientesin 11 (28.9%)durantepatients,o seguimentoand Barrett’sem longoesophagusprazo. Objetivo:(5.7%) and jejunitis (10.5%) were also observed. Hiatal hernia was the most frequent finding observed in 15 Avaliar o impacto da DAPE e tratamento endoscópico pós-operatório no comportamento (39.5%) patients, and most (10.5%) of these patients appeared with concomitant anastomotic dasstrictures.varizesAesofágicaslong blind jejunale recidivaloophemorrágica,was detected indeonepacientes(2.6%) patient.esquistossomóticos.Nearly 75% of theMétodos:patients Foramhad hypotensiveestudadoslower36 pacientesesophagealcomsphincterseguimento(9.61±4.05superiormmHg),a cinco17.4% anos,had hypomotilitydistribuídosofemthe doisesophagealgrupos:body,quedaandda64.7%pressãohadportalpathologicabaixoacidde 30%refluxe(%acimatimedepH30%<4=6.98±5.5;comparadosDeMeester’scom o calibrescore=32.4±21.15).das varizes esofágicasCONCLUSION:no pós-operatórioAlthough rare, itprecoceis possiblee tardioto observealémgastroesophagealdo índice de recidivareflux and other important postoperative symptoms after LGB, which are associated with anatomic and hemorrágica. Resultados physiologic abnormalities at the esophagogastric junction and proximal gastric pouch.