Gastroesophageal reflux disease and severe obesity: Fundoplication or bariatric surgery?

Increases in the prevalence of obesity and gastroesophageal reflux disease (GERD) have paralleled one another over the past decade, which suggests the possibility of a linkage between these two processes. In both instances, surgical therapy is recognized as the most effective treatment for severe, refractory disease. Current surgical therapies for severe obesity include (in descending frequency) Roux-en-Y gastric bypass, adjustable gastric banding, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch, while fundoplication remains the mainstay for the treatment of severe GERD. In several large series, however, the outcomes and durability of fundoplication in the setting of severe obesity are not as good as those in patients who are not severely obese. As such, bariatric surgery has been suggested as a potential alternative treatment for these patients. This article reviews current concepts in the putative pathophysiological mechanisms by which obesity contributes to gastroesophageal reflux and their implications with regards to surgical therapy for GERD in the setting of severe obesity

Defining Surgical Quality in Gastric Cancer: A RAND/UCLA Appropriateness Study

National Health ServiceUniv Toronto, Dept Surg, Toronto, ON, CanadaUniv Toronto, Dept Med, Toronto, ON, CanadaInst Clin Effectiveness Studies, Toronto, ON, CanadaSunnybrook Res Inst, Toronto, ON, CanadaDalhousie Univ, Dept Surg, Halifax, NS B3H 4H2, CanadaUniv Calgary, Dept Surg, Calgary, AB, CanadaMaimonides Hosp, Dept Surg, Brooklyn, NY 11219 USAMem Sloan Kettering Canc Ctr, Dept Surg, New York, NY 10021 USAUniversidade Federal de São Paulo, São Paulo, BrazilBrown Univ, Dept Surg, Providence, RI 02912 USAOhio State Univ, Dept Med, Columbus, OH 43210 USAOhio State Univ, Dept Pharmacol, Columbus, OH 43210 USARoyal Marsden Hosp, Dept Med, Sutton, Surrey, EnglandUniv Texas MD Anderson Canc Ctr, Dept Radiat Oncol, Houston, TX 77030 USAUniv Texas MD Anderson Canc Ctr, Dept Surg Oncol, Houston, TX 77030 USAYonsei Univ, Coll Med, Dept Surg, Seoul, South KoreaUniv Chicago, Dept Surg, Chicago, IL 60637 USACanc Inst Hosp, Dept Surg, Tokyo, JapanLeiden Univ, Med Ctr, Dept Surg, Leiden, NetherlandsUniv Michigan Hlth Syst, Dept Surg, Ann Arbor, MI USAUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc