The Impact of Vertical-Banded Gastroplasty and Subsequent Revision on the Development and Severity of GERD

Introduction: Vertical-banded gastroplasty (VBG) is a form of bariatric surgery intended to treat morbid obesity. This technique was highly prevalent until long-term complications and more effective procedures were identified. Among the adverse effects were reports of weight regain, gastroesophageal reflux disease (GERD), esophagitis, and an increasing need for revision surgery. Despite these data, VBG is still widely endorsed as a viable option for weight loss surgery. This study was aimed at addressing the gap in literature regarding the effect of VBG and subsequent revision surgery on the rate and severity of GERD. Methods: Retrospective chart review was performed on patients who underwent VBG from 2006 to 2012 and required revision with either band removal or conversion surgery to Rouxen-Y Gastric Bypass (RYGB) at a large academic center. All patients underwent esophagogastroduodenoscopy (EGD) prior to revision. Available esophageal manometry, pH monitoring, and impedance planimetry were reviewed. GERD severity preand post-revision was standardized as number of days per week patient reported symptoms. Initiation of medical therapy with proton pump inhibitors, H2 receptor antagonists, and antacids was evaluated. Results: While 43% of patients reported GERD symptoms prior to VBG, 100% developed GERD post-operatively (n523). Symptom severity significantly increased after VBG (p , 0.0001), requiring initiation of medical therapy in over 50% of patients. Revision led to a decrease in symptom severity (P50.0041) and need for medical therapy (p , 0.0001). The band removal group (n511) had more severe symptoms than the conversion group (n512) (P50.0437). The average weight of the band removal group was 111.4 kg versus 91.6 kg in the conversion group (P50.0246). [Table] Conclusion: The prevalence of GERD and need for medical therapy was significantly increased in patients who underwent VBG and those who had subsequent band removal without conversion to RYGB. GERD severity and weight significantly decreased after conversion compared to band removal alone. Many patients without suggestive endoscopic findings or GERD symptoms prior to VBG developed GERD post-operatively, suggesting a strong anatomical pathophysiology. These data suggest that patients with a high risk of developing GERD or pre-existing symptoms should not be considered for this technique. Conversion to RYGB appears superior to band removal alone when assessing the prevalence of GERD and durability of subsequent weight loss.