Laparoscopic Anti-Reflux Surgery is Effective in Obese Patients with Gastro-Oesophageal Reflux Disease

Ng, Vivien; Booth, Michael; Stratford, J.; Jones, Linda; Sohanpal, J.; Dehn, T. C. B.

doi:10.1308/003588407x205323

Cited by 26 publications

(50 citation statements)

References 21 publications

(25 reference statements)

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“…Following laparoscopic antireflux surgery, dysphagia has been reported to significantly improve from preoperative values [47,188,197,198,[200][201][202][203][204] (level II-III). Despite reports of improved dysphagia following surgery, postoperative dysphagia remains a significant problem, with reported reoperation rates ranging from 1.8 to 10.8% [33,34,38,39,143,196,[205][206][207] (level I-III) and endoscopic dilatation rates ranging from 0 to 25% [34,121,143,145,189,195,196,[208][209][210][211][212][213] (level I-III). Although perioperative and early postoperative dysphagia have been reported as high as 76% [191] (level II), the majority of studies show early and mid dysphagia rates, up to 1 year postoperatively, of less than 20% [33,34,38,39,44,47,120,122,189,191,192,195,196,199,200,…”

Section: Discussionmentioning

confidence: 99%

“…The long-term effectiveness of fundoplication in obese individuals (BMI [ 30kg/m 2 ) has been questioned due to higher failure rates [143,144] (level II-III) compared with normal-weight patients. Nevertheless, others have reported equivalent outcomes in obese and normal-weight individuals [145][146][147][148] (level II-III). Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the most effective and advantageous treatment option for GERD in the morbidly obese patient [149,150], since it treats GERD effectively and provides the additional benefit of weight loss and improvement in comorbidities, and is therefore the procedure of choice by many experts [151][152][153][154][155][156] (level II-III).…”

Section: Recommendationmentioning

confidence: 99%

“…One report demonstrated a significant decrease in the incidence of wrap herniation from 26 to 8% with the use of a mesh buttress at the hiatus [227] (level I). Reoperation rates also vary according to technique, indication, and follow-up and have been reported to range from 0 to 15% [32, 33, 39, 41, 43, 45, 47, 107, 109, 110, 112, 119, 121, 123, 145,157,188,195,196,200,201,204,214,234,241,242] (level II-III).…”

Section: Objective Outcomesmentioning

confidence: 99%

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Guidelines for surgical treatment of gastroesophageal reflux disease

et al. 2010

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PreambleThe guidelines for the surgical treatment of gastroesophageal reflux disease (GERD) are a series of systematically developed statements to assist physicians and patient decisions about the appropriate use of laparoscopic surgery for GERD. The statements included in this guideline are the product of a systematic review of published literature on the topic, and the recommendations are explicitly linked to the supporting evidence. The strengths and weaknesses of the available evidence are highlighted and expert opinion sought where the evidence is lacking. This is an update of previous guidelines on this topic (last revision 06/2001) as new information has accumulated. DisclaimerGuidelines for clinical practice are intended to indicate preferable approaches to medical problems as established by experts in the field. These recommendations will be based on existing data or a consensus of expert opinion when little or no data are available. Guidelines are applicable to all physicians who address the clinical problem(s) without regard to specialty training or interests, and are intended to indicate the preferable, but not necessarily the only, acceptable approaches due to the complexity of the healthcare environment. Guidelines are intended to be flexible. Given the wide range of specifics in any health care problem, the surgeon must always choose the course best suited to the individual patient and the variables in existence at the moment of decision.Guidelines are developed under the auspices of the Society of American Gastrointestinal and Endoscopic Surgeons and its various committees, and approved by the Board of Governors. Each clinical practice guideline has been systematically researched, reviewed, and revised by the guidelines committee, and reviewed by an appropriate multidisciplinary team. The recommendations are therefore considered valid at the time of its production based on the data available. Each guideline is scheduled for periodic review to allow incorporation of pertinent new developments in medical research knowledge, and practice. Literature review methodWe identified 448 relevant articles. The abstracts were reviewed by four committee members (D.S., W.W.H., P.R.R., G.P.K.) and divided into the following categories:(a) Randomized studies, metaanalyses, and systematic reviews (b) Prospective studies (c) Retrospective studies (d) Case reports (e) Review articles Randomized controlled trials, metaanalyses, and systematic reviews were selected for further review, along with prospective and retrospective studies that included at least 50 patients. Studies with smaller samples were considered when additional evidence was lacking. The most recent reviews were also included. All case reports, older reviews, and smaller studies were excluded. According to these exclusion criteria, 227 articles were reviewed. Whenever the available evidence from level I studies was considered to be adequate, lower evidence level studies were not considered. A review of the available evidence on endoluminal treatment of...

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Section: Discussionmentioning

confidence: 99%

Section: Recommendationmentioning

confidence: 99%

Section: Objective Outcomesmentioning

confidence: 99%

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Guidelines for surgical treatment of gastroesophageal reflux disease

et al. 2010

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“…However, patient selection is essential to achieving a good outcome [27] . To date, few studies have examined the long-term efficacy and durability of traditional anti-reflux procedures such as Nissen fundoplication in the setting of severe obesity, and results have been conflicting [18][19][20][21][22] . It has been suggested that laparoscopic anti-reflux surgery is associated with a higher failure rate in obese patients because of intraoperative technical difficulties as well as increased intra-abdominal pressure postoperatively [28] .…”

Section: Discussionmentioning

confidence: 99%

“…The management of GORD in obese patients remains contentious with no consensus or published guidelines. Data are conflicting regarding the long-term efficacy of fundoplication in obese individuals compared with normal weight counterparts [18][19][20][21][22] . Nevertheless, most surgeons would agree that treatment of GORD in obese and non-obese patients requires different strategies [23] .…”

Section: Introductionmentioning

confidence: 99%

Upper gastrointestinal surgeon attitudes towards management of refractory gastroesophageal reflux disease in obese patients

Al‐Khyatt¹,

Awad²,

Leeder³

2018

MIS

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Aim: The marked increase in prevalence of obesity has been associated with an increase in obese patients seeking surgical treatment for refractory gastroesophageal reflux disease (GORD). The management of GORD in such patients remains contentious with no published guidelines.Methods: A snapshot 9-item online survey was undertaken to elicit professional opinions of UK surgeons regarding the surgical management of refractory GORD in obese patients.Results: Eighty-two percent and 51% of surgeons performed more than 10 anti-reflux procedures and more than 10 bariatric procedures per year, respectively. Nearly 80 of responders would consider laparoscopic fundoplication as the preferred option for management of refractory GORD in patients with body mass index (BMI) of 30-34.9 kg/m 2 . In contrast, 58% and 80% would discuss bariatric surgery as an alternative treatment option for refractory GORD in patients with BMI 35-39.9 and ≥ 40 kg/m 2 , respectively. Moreover, a bariatric procedure was considered the preferred option by 74% of respondents for patients with BMI ≥ 40 kg/m 2 with refractory GORD, and by 58% for BMI ≥ 35 patients with refractory GORD and significant comorbidities. Eighty percent of surgeons agreed that laparoscopic Roux en-Y gastric bypass (LRYGB) was the preferred bariatric procedure for the management of obese patients with documented GORD. Conclusion:Our survey demonstrated that amongst UK upper gastrointestinal surgeons, bariatric surgery, specifically LRYGB, was a preferred option for management of patients with a BMI ≥ 35 kg/m 2 and refractory GORD. Updated national guidelines are necessary to inform consensus on the management of GORD in obese patients.

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