Vertical banded gastroplasty or gastric banding for morbid obesity: Effects on gastro-oesophageal reflux

Objective: To assess the effect of vertical banded gastroplasty and gastric banding on the development of gastro-oesophageal reflux using both subjective and objective methods. Design: Prospective, randomised study. Setting: Teaching hospital, Sweden. Subjects: 50 consecutive, morbidly obese patients (mean (SD) body mass index (BMI) 42.5 (5), 27 women and 23 men; mean age 48 years, range 38-57 years). Interventions: Vertical banded gastroplasty (n = 24) or gastric banding (n = 26). Main outcome measures: Results of evaluation by standardised questionnaire, 24-hour ambulatory pH-metry, and endoscopy. Results: After six months the mean (SD) BMI had decreased to 34.4 (5.7), with no differences between the groups. Mild dysphagia was somewhat more common (13 compared with 1) but the incidence of heartburn (8 compared with 17), and acid regurgitation (12 compared with 14) were less after the operation; 3 patients developed erosive oesophagitis, two in the vertical banded group and one in the banding group. Ambulatory pH-metry readings did not change significantly from preoperatively and there were no differences between the two operations. One patient developed pathological reflux, and in three the values returned to the normal range. Conclusion: Gastric restriction operations including those with a narrow stoma that causes outflow obstruction do not seem to increase the incidence of reflux in patients with functioning antireflux barriers.