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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Can Fat Content And Muscle Weight Cause Any Problem To Nissen Fundoplication?

I went to see a surgeon yesterday about a possible Nissen Fundoplication to correct a GERD problem



According to the Dr., Nissen Fundoplication requires I have a BMI no higher the 25. My BMI is in the low 40s. I weighted in yesterday at 250lbs At my height, I’d need to lose approximately 100lbs, something both the Dr. and I see as unrealistic.



However, he said he would do the surgery if I lost 35lbs, brining my weight to 215lbs. But even if I do, my BMI would still be in the 30s. For years I have tried to bring my weight down to below 220 through diet and exercise and just couldn't do it. So the risk would still be high for the procedure to fail.



Do you think the risk is still too high even at a BMI in the low 30s? Does the BMI take into account muscle weight vs. fat weight? When considering this type of surgery does fat vs. muscle weight matter? My body type is rather muscular.

Tue, 18 Apr 2017
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General Surgeon 's  Response
Yes.indeed.
The more fat of the body means it is likely to be everywhere and disproportionate. The fact that you have been advised Nissen Fundoplication,it also means the muscles are also relatively weak around the lower part of gullet with abundant fat. So high BMI carries a risk of recurrence. This explains why surgeons prefer acceptable 30 BMI as cutoff and advised significant weight control. You have also option of Bariatric surgery to immediately benefit weight reduction.This may as well obviate need for Plication.Please weigh the options before you.
By the way, BMI is index of fat weight spread over the surface area of body with no reference to muscle weight
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Can Fat Content And Muscle Weight Cause Any Problem To Nissen Fundoplication?

Yes.indeed. The more fat of the body means it is likely to be everywhere and disproportionate. The fact that you have been advised Nissen Fundoplication,it also means the muscles are also relatively weak around the lower part of gullet with abundant fat. So high BMI carries a risk of recurrence. This explains why surgeons prefer acceptable 30 BMI as cutoff and advised significant weight control. You have also option of Bariatric surgery to immediately benefit weight reduction.This may as well obviate need for Plication.Please weigh the options before you. By the way, BMI is index of fat weight spread over the surface area of body with no reference to muscle weight