Obesity adversely affects the outcome of antireflux operations

Perez, Alexander; Moncure, Ashby C.; Rattner, David W.

doi:10.1007/s004640000392

Cited by 233 publications

(154 citation statements)

References 17 publications

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“…However, a small number of patients from all the groups postoperatively graded themselves as Visick III or IV on account of recurrent reflux symptoms, or side effects of the anti-reflux surgery (gas bloat, postprandial fullness, early satiety, inability to belch and dysphagia). 9 Nevertheless, our findings do not support the premise that obesity is the cause of marked increase in failure rate as reported by Perez et al 4 Follow-up of patients is a difficulty encountered in many studies, as patients either refuse or become uncontactable for a variety of reasons. Similar to the problems Smith et al 19 encountered, we have found it difficult to obtain meaningful numbers of patients for follow-up after 1 year.…”

Section: Discussioncontrasting

confidence: 84%

“…There was no weight limit on those operated on in this study; therefore, there was no limit on the BMI. Perez et al 4 supported the idea that intensive efforts at weight loss should be maintained pre-operatively since an increased BMI adversely affects surgical outcome. However, the value of weight reduction pre-operatively remains unproven and, in reality, may prove to be difficult and unrealistic to achieve.…”

Section: Discussionmentioning

confidence: 98%

“…4 The aim of this study was to assess the effect of increased BMI on the surgical outcome of laparoscopic anti-reflux procedures by comparing the effectiveness of surgery in terms of symptom control and patient satisfaction between obese and non-obese patients.…”

mentioning

confidence: 99%

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

Booth

Stratford

et al. 2007

annals

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INTRODUCTION Obesity has long been regarded as a risk factor for the development of gastro-oesophageal reflux disease (GORD). It has been claimed that surgical efficacy of laparoscopic anti-reflux operations is decreased in obese patients. The aim of this study was to assess whether laparoscopic anti-reflux surgery is effective in obese patients with GORD compared to non-obese patients. PATIENT AND METHODS A total of 366 patients (mean age 44 years; range, 12–86 years) underwent laparoscopic anti-reflux surgery between 1997–2003. Of these, 74 patients were considered obese; 58 patients had a body mass index (BMI) of 30–34 kg/m2 and 16 were classified as morbidly obese with a BMI ≥ 35 kg/m2. Pre-operative symptomatic scoring, indications for surgery, pH studies, operative times and complications were compared between obese and non-obese patients. Symptomatic outcome and Visick score between the two groups were assessed at 6 weeks, 6 months and 1 year following surgery. RESULTS Failure of medical treatment was the main reason for surgery in all groups. Operative time was longer in obese patients (mean time 93 min compared to 81 min; P = 0.0007), the main difficulty being gaining access because of their body habitus. All groups found the procedure to be effective in symptomatic outcome, 91% of obese patients compared to 92% of non-obese patients scored Visick I or II at 6 weeks' postoperatively. Similar Visick scoring was shown between the two groups at 6 months and 1 year, and in the morbidly obese group. CONCLUSIONS The outcome of laparoscopic anti-reflux surgery is similar between obese and non-obese patients with no trend towards a worse outcome in the obese or morbidly obese. Obesity should not be seen as a contra-indication, although it may be more technically challenging in this group of patients. Good results can be achieved in obese patients.

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Section: Discussioncontrasting

confidence: 84%

Section: Discussionmentioning

confidence: 98%

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

Booth

Stratford

et al. 2007

annals

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“…1,2,5,7,8,11,13 Careful selection has been recommended for patients with GERD 2,14 and also when introducing other advanced laparoscopic procedures in a nonacademic community hospital setting to ensure excellent outcomes. 15 Some studies have shown poor long-term outcomes after laparoscopic Nissen fundoplication in obese patients, 16 and on this basis no patients with a BMI greater than 35 were offered surgery in the present study. Once good outcomes are established the indications can be broadened to include patients with a BMI greater than 35.…”

Section: Discussionmentioning

confidence: 73%

Quality of life and surgical outcomes following laparoscopic surgery for refractory gastroesophageal reflux disease in a regional hospital

Hwang

2012

Can J Surg

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Background: Gastroesophageal reflux disease (GERD) is a prevalent condition leading to poor quality of life (QOL) in patients with refractory symptoms. Laparoscopic antireflux (LAR) surgery has been shown to improve QOL, and I sought to examine the surgical and QOL outcomes associated with LAR surgery over a 3-year period at a regional hospital. Methods:Patients were given GERD-health related quality of life (GERD-HRQL) and SF-36 questionnaires preoperatively, at 6 months and at 12 or more months after surgery. I collected data on demographic and clinical characteristics and surgical outcomes. Results:Of the 342 patients referred for GERD or dysphagia, 26 received LAR surgery during the study period. All 26 patients had symptoms refractory to medications; 19 had atypical symptoms and 8 had some form of chronic pain syndrome (CPS). The mean duration of surgery was 125 minutes. There were no conversions, complications, 30-day readmissions or deaths. Three patients stayed 2 days in hospital and 23 stayed overnight. One patient required esophageal dilation for persistent dysphagia. Two patients resumed medication for recurrent symptoms and 24 remained medication free. There were significant improvements in GERD-HRQL scores in all patients. Patients with CPS had no improvements in SF-36 scores, whereas patients without CPS showed significant improvement. Conclusion:Excellent surgical outcomes in LAR surgery can be obtained with careful patient selection at a nonacademic regional hospital. Although GERD-HRQL improved in all patients, patients with CPS showed no improvement in general health QOL scores after LAR surgery. Careful patient counselling should be employed when offering LAR surgery to patients with CPS.Contexte : Le reflux gastro-oesophagien pathologique (RGOP) chronique est un problème prévalent qui entraîne une mauvaise qualité de vie (QDV) chez les patients atteints de symptômes réfractaires. Il a été démontré que la laparoscopie antireflux (LAR) améliore la QDV, et j'ai cherché à analyser les résultats chirurgicaux et liés à la QDV associés à une LAR pendant une période de trois ans dans un hôpital régional.

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“…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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Obesity adversely affects the outcome of antireflux operations

Cited by 233 publications

References 17 publications

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

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

Quality of life and surgical outcomes following laparoscopic surgery for refractory gastroesophageal reflux disease in a regional hospital

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

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