My research investigates the incidence, pathophysiology and sequelae of bile reflux in the context of bariatric surgery. 

Nearly two-thirds of Australian adults are overweight or obese – more than two-thirds (70.8%) of adult males, and over half (56.3%) of adult females. Medical treatment of obesity continues to yield disappointing results. Obesity surgery consistently results in effective and sustained weight loss with improved quality of life, and remission of obesity-related diseases. As such, many Australians are turning to surgery to lose weight.

Obesity is an independent risk factor for development of reflux and weight-loss can significantly improve symptoms. Some weight-loss operations, however, can promote bile reflux due to the anatomical alterations, and symptomatic reflux can persist despite weight loss. Bile acids, in conjunction with gastric acid, can cause reflux-type symptoms, and also the development of Barrett’s oesophagus which is a pre-cursor for oesophageal cancer.

Recent advances in obesity surgery include the introduction of new surgical techniques. Currently, the laparoscopic Roux-en-Y gastric bypass (LRYGP) and laparoscopic sleeve gastrectomy (LSG) are the most commonly performed surgical procedures for weight loss worldwide. A newer alternative operative technique is the laparoscopic single anastomosis gastric bypass (LSAGB). This technique is growing in popularity and as described by proponents of the technique, there are many advantages: it is quicker to learn; has a shorter operative time (and thus shorter anaesthetic); reduces risk of complications (one anastomosis rather than two) and weight loss as well as glucose tolerance outcomes are comparable to the other techniques. Despite these results, LSAGB is not being as rapidly adopted by bariatric surgeons as might be expected. The low uptake relates to controversy concerning the theoretical long-term harm and potentially carcinogenic effects of bile reflux into the gastric remnant and the oesophagus after LSAGB.

My clinical trial is the first objective study looking at the incidence of bile reflux in these operative techniques.With current data showing favourable results, including improved efficacy and decreased risk of complications, increased utilisation of the technique will result in improved short-term and long-term patient outcomes. Awareness of the incidence of bile reflux post-operatively will allow clinicians to treat any reflux early, preventing or at least delaying potentially detrimental health outcomes. These interventions will translate into decreased health expenditure, providing net health and economic benefit.