Bệnh nhân béo phì có tỷ lệ thất bại cao với fundoplication, do đó, chúng tôi khuyên bệnh nhân béo phì giảm cân trước khi tiến hành một hoạt động. Thay thế cho các cá nhân bị béo phì | 70 Advanced Therapy in Gastroenterology and Liver Disease Confounding Considerations Antireflux surgery should be approached more cautiously in certain groups of patients. Obese patients have a high failure rate with fundoplication therefore we recommend obese patients lose weight before proceeding with an operation. The alternative for morbidly obese individuals body mass index 40 with GERD is a Roux-en-Y gastric bypass. This operation not only aids in weight loss thus providing other health benefits but it is an extremely effective antireflux procedure. Patients with multiple comorbidities and previous upper abdominal operations should be approached more cautiously. Patients with severe cardiopulmonary disease may not tolerate general anesthesia or the pneumoperitinum required to do the operation laparoscopically. Former upper Gi or gastric surgery may preclude safe or effective access to the hiatus or make the use of the stomach to construct the wrap more difficult and sometimes impossible. The most important factor is probably the experience and comfort of the surgeon because multiple technical subtleties encountered at the time of surgery can affect long-term outcome. Potential Side Effects surgery is not without potential side effects the most common being dysphagia bloating diarrhea and early satiety. Inappropriate geometry of the wrap tightness of the crural closure and esophageal peristaltic function are all variables that may lead to difficulties swallowing after an operation. The reported incidence varies from 2 to 5 Anvari and Allen 2003 Atwood et al 1992 . Although some degree of dysphagia is common immediately after surgery it generally resolves quickly with expectant management alone. The need for postoperative dilation is unusual and the need to take down the fundoplication is even less so. Gas bloating can occur and is the result of swallowed air that cannot escape by belching secondary to the new wrap. Early satiety may result because the gastric
