Walter Lindstrom

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  1. Hi folks, A member asked me to comment on this even though it's an older thread so I'm happy to try helping out. The RNY gastric bypass is considered the anti-reflux surgery of choice by surgeons in the field and I'm attaching a PDF with more information that might help. The Recommendation is on page 8: "Due to concerns for higher failure rates after fundoplication in the morbidly obese patient (BMI >35 kg/m2) and the inability of fundoplication to address the underlying problem (obesity) and its associated comorbidities, gastric bypass should be the procedure of choice when treating GERD in this patient group..." GERD certainly is a central issue for band removal / conversion cases but also for sleeves which need revising due to new-onset GERD, which can be quite severe. Documenting the severity of the GERD will matter a great deal and it will be important to have a full reflux work-up establishing a failure of lifestyle modifications (e.g., eliminating acid reflux inducing foods like coffee, chocolate, red sauces, etc.), elevating head of bed, not eating after certain hours etc. with regard to reflux being improved. After lifestyle management "fails" it is important to demonstrate a failure of medical management with anti-reflux medicines will help establish medical necessity. It is really quite a misunderstood and under-appreciated comorbidity! guidelines-for-surgical-treatment-of-gastroesophageal-reflux-disease-gerd.pdf Hope this helps. Email or call us if there are questions or concerns I can help with. The link is in my signature.