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The role of body mass index in determining clinical and quality of life outcomes after laparoscopic anti-reflux surgery

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Abstract

Background

Current literature is conflicted regarding the efficacy of laparoscopic anti-reflux surgery (LARS) among obese patients complaining of pathologic reflux or otherwise symptomatic hiatal hernias. Controlling for other factors, this study examined the influence of preoperative body mass index (BMI) on clinical and subjective quality of life (QOL) outcomes following LARS.

Methods

Patients who underwent LARS between February 2012 and April 2018 were subdivided into four BMI stratified categories according to CDC definitions: normal (18.5 to < 25), overweight (25.0 to < 30), obese Class 1 (30 to < 35), and a combination of obese Class 2 (35 to < 40) and Class 3 (≥ 40). Patient demography, perioperative data, and QOL data were collected. QOL was assessed utilizing four validated survey instruments: the Reflux Symptom Index (RSI), Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL), Laryngopharyngeal Reflux Health-Related Quality of Life (LPR-HRQL), and a modified Quality of Life in Swallowing Disorders (mSWAL-QOL) surveys.

Results

In this study, 869 patients were identified (213 NL, 323 OW, 219 OC1, 114 OC23). The majority of patients in each subgroup were female (65% NL, 68% OW, 79% OC1, 74% OC23) with similar rates of underlying hypertension, hyperlipidemia, and diabetes mellitus. Coronary artery disease rates between groups were statistically significant (p = .021). Operative time, length of hospital stay, and rates of 30-day readmission and reoperation were similar between groups. Among postoperative complications, rates of arrhythmia and UTI were more commonly reported in OC1 and OC23 populations. When assessed utilizing the RSI, GERD-HRQL, LPR-HRQL, and mSWAL-QOL instruments, QOL was similar among all groups (mean follow-up 15 months) irrespective of BMI.

Conclusion

These findings suggest LARS in the overweight, obese, and morbidly obese populations—when compared to normal-weight cohorts in short-term follow-up—may have similar value in addressing pathological reflux manifestations and conveying quality of life benefits without added morbidity or mortality.

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Acknowledgement

Copy editing and review services provided by Elizabeth Lewis.

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Authors and Affiliations

  1. Department of Surgery, Anne Arundel Medical Center, 2000 Medical Parkway, Belcher Pavilion, Suite 106, Annapolis, MD, 21401, USA

    Zachary Sanford, Shyam Jayaraman, Adam S. Weltz, H. Reza Zahiri & Adrian Park

  2. Department of Surgery, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA

    Adrian Park

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  1. Zachary Sanford
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  2. Shyam Jayaraman
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  3. Adam S. Weltz
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  4. H. Reza Zahiri
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  5. Adrian Park
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Correspondence to Adrian Park.

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Dr. Jayaraman, Dr. Sanford, Dr. Weltz, Dr. Zahiri and Dr. Park have no conflicts of interest to declare. No financial support was received for this study.

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Sanford, Z., Jayaraman, S., Weltz, A.S. et al. The role of body mass index in determining clinical and quality of life outcomes after laparoscopic anti-reflux surgery. Surg Endosc 34, 646–657 (2020). https://doi.org/10.1007/s00464-019-06811-0

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  • DOI: https://doi.org/10.1007/s00464-019-06811-0

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