Gastro-oesophageal reflux before and after vertical banded gastroplasty in the treatment of obesity.

OBJECTIVE: To study the long term effect of vertical banded gastroplasty on lower oesophageal sphincter pressure.
DESIGN: Prospective study.
SETTING: University hospital, Sweden.
SUBJECTS: 21 morbidly obese patients (mean body mass index 42.5).
INTERVENTIONS: Vertical banded gastroplasty, together with measurements of endoscopic grade, oesophageal manometry, and 24 hour pH before, and a mean of 38 months after, operation. MAIN OUTCOME MEASURES: Weight, grade of oesophagitis according to the Savary-Miller classification, number of episodes of reflux, percentage of time that the pH was < 4, and lower oesophageal sphincter pressure.
RESULTS: Before operation 5/14 patients (36%) had evidence of oesophagitis, and 12/21 (57%) had evidence of reflux disease. Two patients had abnormally low lower oesophageal sphincter pressure ( < 10 mm Hg). A mean (SEM) of 32 months after operation (range 6-49) the mean body mass index was 32.7 (1.2), and after a mean of 38 months paired data showed that there had been no significant changes in manometric (n = 11) or 24 hour pH (n = 10) measurements, or in endoscopic grading (n = 7).
CONCLUSION: Vertical banded gastroplasty used in the treatment of morbid obesity does not affect the antireflux function of the lower oesophageal sphincter.