Gastric Bypass After Previous Anti-reflux Surgery

NCT01041105 | Completed DMC

• 2 other identifiers: CMC IRB No. 2008086U1111-1112-9919
• Study Type: observational
• Target: 22
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this study is to describe the clinical presentation, indications, and operative treatment as well as assess the morbidity, mortality, and overall performance of revisional Roux-en-Y gastric bypass (RYGB) after either failed or functional antireflux surgery "ARS" in obese patients. With such information, we hope to determine which features might assist us in advancing our knowledge about Gastro-Esophageal Reflux Disease "GERD", the best option for primary ARS, and mechanisms of failure in the obese population as well as in identifying predictors of outcome after revisional surgery in this population.

Conditions

Clinically Severe Obesity; Gastroesophageal Reflux Disease

Keywords

Obesity; Gastroesophageal Reflux Disease; Nissen funduplication; Antireflux surgery; Revisional Gastric Bypass; Re-operative bariatric surgery; Bariatric surgery; Nissen; Conversion of Nissen to Gastric Bypass

Outcome Measures

Primary Outcomes (3)

• Morbidity and mortality

  at discharge, 1 week, 3 weeks, 8 weeks, 3 months, 6 months, 1 year and annually thereafter for up to 4 years

• Remission or improvement of GERD-related symptoms

  6 months, 1 year and annually thereafter for up to 4 years

• Weight loss expressed as Body Mass Index and Percentage of excess weight loss

  6 months, 1 year, and annually thereafter for up to 4 years

Secondary Outcomes (3)

• Remission or improvement of comorbidities

  6 months, 1 year, and annually thereafter for up to 4 years

• Length of operative time which is defined as the time duration of operation measured in minutes from the first skin incision to the final closure of the skin incision

  It is measured in minutes from the first skin incision to the final closure of the skin incision at the time of revisional surgery under study. It is a transoperative measure of outcome of the surgery under study

• Length of Hospital Stay which is a measured of surgical recovery quantified and reported in days. It is a hospital pre-discharge traditional measure of outcome.

  It is measured in days from the admission date to the discharge date for the hospitalization pertaining to revisional surgery under study

Study Arms (1)

Gastric bypass after previous Nissen

Eligibility Criteria

• Age: 18 Years - 60 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)
• Sampling Method: Non-Probability Sample

Study Population

Patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) after a previous functional or failed anti-reflux procedure and met National Institutes of Health criteria for bariatric surgery.

You may qualify if:

• Status post, either open or laparoscopic, primary Nissen fundoplication with all the following requirements:
• Met NIH criteria for bariatric surgery
• With functional or failed antireflux surgery (Nissen fundoplication)
• Laparoscopic approach for revisional surgery

You may not qualify if:

• Any other type of revisional bariatric procedure
• Nonstandard revisional RYGB surgery
• Open approach for revision surgery
• Missing records and/or unreachable patients with scant information for analysis

Sponsors & Collaborators

• University of California, San Francisco: lead

Study Sites (1)

UCSF Fresno Center for Medical Education and Research

Fresno, California, 93701, United States

Location

Related Publications (38)

• Higa KD, Boone KB, Ho T, Davies OG. Laparoscopic Roux-en-Y gastric bypass for morbid obesity: technique and preliminary results of our first 400 patients. Arch Surg. 2000 Sep;135(9):1029-33; discussion 1033-4. doi: 10.1001/archsurg.135.9.1029.

  PMID: 10982506 BACKGROUND

• Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA. 2004 Jun 16;291(23):2847-50. doi: 10.1001/jama.291.23.2847.

  PMID: 15199035 BACKGROUND

• McTigue KM, Harris R, Hemphill B, Lux L, Sutton S, Bunton AJ, Lohr KN. Screening and interventions for obesity in adults: summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2003 Dec 2;139(11):933-49. doi: 10.7326/0003-4819-139-11-200312020-00013.

  PMID: 14644897 BACKGROUND

• Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004 Oct 13;292(14):1724-37. doi: 10.1001/jama.292.14.1724.

  PMID: 15479938 BACKGROUND

• Christou NV, Sampalis JS, Liberman M, Look D, Auger S, McLean AP, MacLean LD. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004 Sep;240(3):416-23; discussion 423-4. doi: 10.1097/01.sla.0000137343.63376.19.

  PMID: 15319713 BACKGROUND

• Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, Lamonte MJ, Stroup AM, Hunt SC. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007 Aug 23;357(8):753-61. doi: 10.1056/NEJMoa066603.

  PMID: 17715409 BACKGROUND

• Sjostrom L, Narbro K, Sjostrom CD, Karason K, Larsson B, Wedel H, Lystig T, Sullivan M, Bouchard C, Carlsson B, Bengtsson C, Dahlgren S, Gummesson A, Jacobson P, Karlsson J, Lindroos AK, Lonroth H, Naslund I, Olbers T, Stenlof K, Torgerson J, Agren G, Carlsson LM; Swedish Obese Subjects Study. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007 Aug 23;357(8):741-52. doi: 10.1056/NEJMoa066254.

  PMID: 17715408 BACKGROUND

• Cremieux PY, Buchwald H, Shikora SA, Ghosh A, Yang HE, Buessing M. A study on the economic impact of bariatric surgery. Am J Manag Care. 2008 Sep;14(9):589-96.

  PMID: 18778174 BACKGROUND

• Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005 Oct 19;294(15):1909-17. doi: 10.1001/jama.294.15.1909.

  PMID: 16234497 BACKGROUND

• Flum DR, Khan TV, Dellinger EP. Toward the rational and equitable use of bariatric surgery. JAMA. 2007 Sep 26;298(12):1442-4. doi: 10.1001/jama.298.12.1442. No abstract available.

  PMID: 17895461 BACKGROUND

• Meguid MM, Glade MJ, Middleton FA. Weight regain after Roux-en-Y: a significant 20% complication related to PYY. Nutrition. 2008 Sep;24(9):832-42. doi: 10.1016/j.nut.2008.06.027.

  PMID: 18725080 BACKGROUND

• Nguyen NT. Reoperations and revisions in bariatric surgery. Surg Endosc. 2007 Nov;21(11):1907-8. doi: 10.1007/s00464-007-9572-6. Epub 2007 Sep 8. No abstract available.

  PMID: 17828427 BACKGROUND

• Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med. 2005 Aug 2;143(3):199-211. doi: 10.7326/0003-4819-143-3-200508020-00006.

  PMID: 16061918 BACKGROUND

• Corley DA, Kubo A. Body mass index and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Gastroenterol. 2006 Nov;101(11):2619-28. doi: 10.1111/j.1572-0241.2006.00849.x. Epub 2006 Sep 4.

  PMID: 16952280 BACKGROUND

• Kubo A, Corley DA. Body mass index and adenocarcinomas of the esophagus or gastric cardia: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev. 2006 May;15(5):872-8. doi: 10.1158/1055-9965.EPI-05-0860.

  PMID: 16702363 BACKGROUND

• Corley DA, Kubo A, Levin TR, Block G, Habel L, Zhao W, Leighton P, Quesenberry C, Rumore GJ, Buffler PA. Abdominal obesity and body mass index as risk factors for Barrett's esophagus. Gastroenterology. 2007 Jul;133(1):34-41; quiz 311. doi: 10.1053/j.gastro.2007.04.046. Epub 2007 Apr 25.

  PMID: 17631128 BACKGROUND

• Edelstein ZR, Farrow DC, Bronner MP, Rosen SN, Vaughan TL. Central adiposity and risk of Barrett's esophagus. Gastroenterology. 2007 Aug;133(2):403-11. doi: 10.1053/j.gastro.2007.05.026. Epub 2007 May 21.

  PMID: 17681161 BACKGROUND

• Fass R. The pathophysiological mechanisms of GERD in the obese patient. Dig Dis Sci. 2008 Sep;53(9):2300-6. doi: 10.1007/s10620-008-0411-y. Epub 2008 Jul 29.

  PMID: 18663576 BACKGROUND

• Jacobson BC. Body mass index and the efficacy of acid-mediating agents for GERD. Dig Dis Sci. 2008 Sep;53(9):2313-7. doi: 10.1007/s10620-008-0414-8. Epub 2008 Jul 16.

  PMID: 18629639 BACKGROUND

• Morgenthal CB, Shane MD, Stival A, Gletsu N, Milam G, Swafford V, Hunter JG, Smith CD. The durability of laparoscopic Nissen fundoplication: 11-year outcomes. J Gastrointest Surg. 2007 Jun;11(6):693-700. doi: 10.1007/s11605-007-0161-8.

  PMID: 17562117 BACKGROUND

• Bammer T, Hinder RA, Klaus A, Klingler PJ. Five- to eight-year outcome of the first laparoscopic Nissen fundoplications. J Gastrointest Surg. 2001 Jan-Feb;5(1):42-8. doi: 10.1016/s1091-255x(01)80012-3.

  PMID: 11309647 BACKGROUND

• Dallemagne B, Weerts J, Markiewicz S, Dewandre JM, Wahlen C, Monami B, Jehaes C. Clinical results of laparoscopic fundoplication at ten years after surgery. Surg Endosc. 2006 Jan;20(1):159-65. doi: 10.1007/s00464-005-0174-x. Epub 2005 Dec 7.

  PMID: 16333553 BACKGROUND

• Morgenthal CB, Lin E, Shane MD, Hunter JG, Smith CD. Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes. Surg Endosc. 2007 Nov;21(11):1978-84. doi: 10.1007/s00464-007-9490-7. Epub 2007 Jul 11.

  PMID: 17623236 BACKGROUND

• O'Boyle CJ, Watson DI, DeBeaux AC, Jamieson GG. Preoperative prediction of long-term outcome following laparoscopic fundoplication. ANZ J Surg. 2002 Jul;72(7):471-5. doi: 10.1046/j.1445-2197.2002.02455.x.

  PMID: 12123502 BACKGROUND

• Power C, Maguire D, McAnena O. Factors contributing to failure of laparoscopic Nissen fundoplication and the predictive value of preoperative assessment. Am J Surg. 2004 Apr;187(4):457-63. doi: 10.1016/j.amjsurg.2003.12.034.

  PMID: 15041491 BACKGROUND

• Campos GM, Peters JH, DeMeester TR, Oberg S, Crookes PF, Tan S, DeMeester SR, Hagen JA, Bremner CG. Multivariate analysis of factors predicting outcome after laparoscopic Nissen fundoplication. J Gastrointest Surg. 1999 May-Jun;3(3):292-300. doi: 10.1016/s1091-255x(99)80071-7.

  PMID: 10481122 BACKGROUND

• Perez AR, Moncure AC, Rattner DW. Obesity adversely affects the outcome of antireflux operations. Surg Endosc. 2001 Sep;15(9):986-9. doi: 10.1007/s004640000392. Epub 2001 Jun 12.

  PMID: 11443428 BACKGROUND

• D'Alessio MJ, Arnaoutakis D, Giarelli N, Villadolid DV, Rosemurgy AS. Obesity is not a contraindication to laparoscopic Nissen fundoplication. J Gastrointest Surg. 2005 Sep-Oct;9(7):949-54. doi: 10.1016/j.gassur.2005.04.019.

  PMID: 16137590 BACKGROUND

• Frezza EE, Ikramuddin S, Gourash W, Rakitt T, Kingston A, Luketich J, Schauer P. Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2002 Jul;16(7):1027-31. doi: 10.1007/s00464-001-8313-5. Epub 2002 May 3.

  PMID: 11984683 BACKGROUND

• Smith SC, Edwards CB, Goodman GN. Symptomatic and clinical improvement in morbidly obese patients with gastroesophageal reflux disease following Roux-en-Y gastric bypass. Obes Surg. 1997 Dec;7(6):479-84. doi: 10.1381/096089297765555205.

  PMID: 9730504 BACKGROUND

• Patterson EJ, Davis DG, Khajanchee Y, Swanstrom LL. Comparison of objective outcomes following laparoscopic Nissen fundoplication versus laparoscopic gastric bypass in the morbidly obese with heartburn. Surg Endosc. 2003 Oct;17(10):1561-5. doi: 10.1007/s00464-002-8955-y. Epub 2003 Jul 21.

  PMID: 12874685 BACKGROUND

• Houghton SG, Romero Y, Sarr MG. Effect of Roux-en-Y gastric bypass in obese patients with Barrett's esophagus: attempts to eliminate duodenogastric reflux. Surg Obes Relat Dis. 2008 Jan-Feb;4(1):1-4; discussion 4-5. doi: 10.1016/j.soard.2007.10.003. Epub 2007 Dec 19.

  PMID: 18069070 BACKGROUND

• Houghton SG, Nelson LG, Swain JM, Nesset EM, Kendrick ML, Thompson GB, Murr MM, Nichols FC, Sarr MG. Is Roux-en-Y gastric bypass safe after previous antireflux surgery? Technical feasibility and postoperative symptom assessment. Surg Obes Relat Dis. 2005 Sep-Oct;1(5):475-80. doi: 10.1016/j.soard.2005.07.004. Epub 2005 Aug 31.

  PMID: 16925273 BACKGROUND

• Kellogg TA, Andrade R, Maddaus M, Slusarek B, Buchwald H, Ikramuddin S. Anatomic findings and outcomes after antireflux procedures in morbidly obese patients undergoing laparoscopic conversion to Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007 Jan-Feb;3(1):52-7; discussion 58-9. doi: 10.1016/j.soard.2006.08.011. Epub 2006 Nov 20.

  PMID: 17116426 BACKGROUND

• Raftopoulos I, Awais O, Courcoulas AP, Luketich JD. Laparoscopic gastric bypass after antireflux surgery for the treatment of gastroesophageal reflux in morbidly obese patients: initial experience. Obes Surg. 2004 Nov-Dec;14(10):1373-80. doi: 10.1381/0960892042583950.

  PMID: 15603654 BACKGROUND

• Zainabadi K, Courcoulas AP, Awais O, Raftopoulos I. Laparoscopic revision of Nissen fundoplication to Roux-en-Y gastric bypass in morbidly obese patients. Surg Endosc. 2008 Dec;22(12):2737-40. doi: 10.1007/s00464-008-9848-5. Epub 2008 Mar 25.

  PMID: 18363066 BACKGROUND

• Donnelly PE, Salgado JJ, Gagne DD, et al. Efficacy of laparoscopic Roux-en-Y gastric bypass (LRYGB) in obese patients with a previous fundoplication. Surg Obes Relat Dis 2007;3: 299-344.

  BACKGROUND

• Ikramuddin S. Surgical management of gastroesophageal reflux disease in obesity. Dig Dis Sci. 2008 Sep;53(9):2318-29. doi: 10.1007/s10620-008-0415-7. Epub 2008 Jul 29.

  PMID: 18663575 BACKGROUND

Related Links

• "Click here for more information about the department sponsor´s web site"

MeSH Terms

Conditions

Gastroesophageal Reflux; Obesity

Condition Hierarchy (Ancestors)

Esophageal Motility Disorders; Deglutition Disorders; Esophageal Diseases; Gastrointestinal Diseases; Digestive System Diseases; Overweight; Overnutrition; Nutrition Disorders; Nutritional and Metabolic Diseases; Body Weight; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Francisco M Tercero, MD

  Research Associate, University of California San Francisco

  STUDY DIRECTOR

• Kelvin D Higa, MD

  Professor of Surgery, University of California San Francisco

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER

Study Record Dates

• First Submitted: December 26, 2009
• First Posted: December 31, 2009
• Study Start: December 1, 2008
• Primary Completion: June 1, 2009
• Study Completion: December 1, 2009
• Last Updated: January 1, 2010

Record last verified: 2009-12

Locations

US (1)