Results of this study show that laparoscopic gastric bypass and laparoscopic Nissen fundoplication are both effective in treating heartburn symptoms and objective acid reflux in morbidly obese patients. The health benefits of weight loss after laparoscopic gastric bypass should make this operation the procedure of choice in the morbidly obese patient with heartburn.

Prevalence of manometric abnormalities in the morbidly obese is high. Presence of a nut cracker-like distal esophagus in the morbidly obese is significant and warrants further evaluation.

Background: Outcomes in patients having surgery for gastroesophageal reflux disease are most commonly determined by symptomatic assessment. Objective testing is usually reserved for symptomatic patients. Hypothesis: To evaluate the relationship between symptomatic and objective outcomes after antireflux surgery. Design: Retrospective analysis of prospectively collected data. Setting: A tertiary care teaching hospital with a comprehensive esophageal physiology laboratory. Interventions: A 360°(Nissen) fundoplication or a 270°(Toupet) posterior fundoplication was performed based on esophageal motility. Twenty-four-hour pH monitoring was used as a gold standard for assessing postoperative acid reflux.

Our data suggest that mesh fixation to the abdominal wall may be avoided in total extraperitoneal repairs without increasing the risk of hernia recurrence and neuropathic complications. The increased risk of recurrence observed with mesh fixation possibly results from selection bias. Large randomized controlled studies are needed to determine whether mesh fixation is truly related to neuropathic complications and the incidence of recurrence.

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