© FD-Communications Inc. Obesity Surgery, 14, 2004 1373 Obesity Surgery, 14, 1373-1380 Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been proven effective against gastroe- sophageal reflux disease (GERD) in morbidly obese patients. We present our experience with revision of antireflux procedures to LRYGBP in obese patients with recurrent GERD, weight gain or a combination of both and discuss the indications and technical con- siderations involved. Methods: Between June 2000 and December 2003, 7 morbidly obese patients with a mean BMI of 37.5 kg/m 2 underwent revision of an antireflux procedure to LRYGBP by our group. Important steps of the revi- sion include dissection of the diaphragmatic crura and gastroesophageal fat pad, reduction and repair of hiatal hernia, and complete take-down of the wrap to avoid stapling over the fundoplication which can cre- ate an obstructed, septated pouch. Results: Mean operative time was 6 hr 12 min and length of stay was 4.8 days. There were 3 major com- plications postoperatively and no deaths. During fol- low-up, 5 patients developed anastomotic strictures and 2 patients were re-explored for gastric remnant herniation and intestinal obstruction. At a mean fol- low-up of 24 (3-44) months, mean excess weight loss was 70.7% and 14/20 (70%) co-morbid conditions were improved or resolved. GERD evaluation with the GERD-HRQL scale showed a significant reduction of GERD scores postoperatively (P=0.006). Conclusions: Although LRYGBP after antireflux surgery is a technically more difficult procedure with a higher morbidity, it is feasible and effective for the treatment of recurrent GERD and worsening obesity with the additional advantage of weight loss and improvement of co-morbidities. Key words: Gastric bypass, laparoscopy, recurrent gastro- esophageal reflux disease, reoperative antireflux surgery, obesity, morbid obesity Introduction Gastroesophageal reflux disease (GERD) is a sig- nificant public health problem affecting up to 40% of the American adult population. 1 It is generally accepted that laparoscopic antireflux surgery (LARS) performed by an experienced surgeon is a maintenance option for the patient with well-docu- mented GERD. 2 Even though a direct cause-effect relationship between obesity and GERD has not been clearly established, obesity is often associated with GERD. As much as 55% of morbidly obese patients presenting for laparoscopic Roux-en-Y gas- tric bypass (LRYGBP) have symptoms of chronic GERD. 3 There is enough evidence in the literature to suggest that obesity adversely affects the out- come of LARS. 4,5 In addition, LRYGBP is currently recommended as an attractive alternative to LARS for the primary treatment of GERD in morbidly obese patients. 3,6,7 Although a recent study has Laparoscopic Gastric Bypass after Antireflux Surgery for the Treatment of Gastroesophageal Reflux in Morbidly Obese Patients: Initial Experience Ioannis Raftopoulos, MD, PhD; Omar Awais, DO; Anita P. Courcoulas, MD, MPH; James D. Luketich, MD Department of Surgery, Division of Thoracic and Foregut Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Reprint requests to: Ioannis Raftopoulos, MD, PhD, UPMC Shadyside Hospital, 5200 Centre Avenue, Suite 715, Pittsburgh, PA 15232, USA. Fax: 412-623-0329; e-mail: raftopoulosi@upmc.edu