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Tobacco use is not associated with increased risk of recurrent reflux 5 years after laparoscopic anti-reflux surgery

  • 2020 SAGES Oral
  • Published:
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Abstract

Introduction

Tobacco use worsens gastrointestinal reflux disease (GERD). Smoking cessation improves GERD symptoms, but its impact on the efficacy of laparoscopic anti-reflux surgery (LARS) is unclear. In this retrospective cohort study, we hypothesized that non-smokers would demonstrate greater long-term improvements in disease-specific quality of life than active smokers.

Methods

Data were maintained in an IRB-approved prospective database, and patients were stratified according to tobacco use. Postoperative follow-up occurred in clinic and long-term follow-up via telephone interview. Outcomes measured were gastroesophageal health-related quality of life (GERD-HRQL) and GERD symptom scale (GERSS) scores, proton pump inhibitor (PPI) cessation, and satisfaction with surgery.

Results

Two hundred and thirty-five patients underwent primary LARS, and 31 (13%) were active smokers with 18 median pack-years [10–30]. Baseline PPI use (96% vs. 94%, p = 0.64), presence of a hiatal hernia (79% vs. 68%, p = 0.13), esophagitis (28% vs. 45%, p = 0.13), and DeMeester score (41.9 vs. 33.6, p = 0.47) were similar. Baseline GERD-HRQL and GERSS scores and their post-surgical decreases were also similar between groups. PPI cessation was achieved in 92% of non-smokers and 94% of smokers (p = 0.79), and GERD-HRQL scores decreased to 4 [1–7] and 5 [0–12], respectively (p = 0.53). After 59 [25–74] months, GERD-HRQL scores were 5 [2–11] and 2 [0–13] (p = 0.61) and PPI cessation was maintained in 69% and 79% of patients (p = 0.59). Satisfaction with surgery was similar between smokers and non-smokers (88% vs. 87%, p = 0.85). Female gender was significantly associated with increased improvements in GERD-HRQL (p < 0.01) and GERSS scores (p = 0.04) postoperatively but not at long-term follow-up. Patients without a hiatal hernia were less likely to achieve long-term PPI cessation compared to those with a hernia (OR 0.23, p < 0.01).

Conclusions

After 5 years, smokers demonstrate similar symptom resolution, PPI cessation rates, and satisfaction with surgery as non-smokers. Active smoking does not appear to negatively impact long-term symptomatic outcomes of LARS.

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Authors and Affiliations

  1. Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, 558 Doan Hall, Columbus, OH, USA

    Vivian L. Wang, Anahita D. Jalilvand, Anand Gupta, Jennwood Chen, Chaitanya Vadlamudi & Kyle A. Perry

  2. Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, N729 Doan Hall, Columbus, OH, 43210, USA

    Kyle A. Perry

Authors
  1. Vivian L. Wang
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  2. Anahita D. Jalilvand
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  3. Anand Gupta
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  4. Jennwood Chen
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  5. Chaitanya Vadlamudi
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  6. Kyle A. Perry
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Correspondence to Kyle A. Perry.

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Drs. Wang, Jalilvand, Chen, Vadlamudi, and Perry, and Mr. Gupta, have no conflicts of interest to disclose.

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Wang, V.L., Jalilvand, A.D., Gupta, A. et al. Tobacco use is not associated with increased risk of recurrent reflux 5 years after laparoscopic anti-reflux surgery. Surg Endosc 35, 4771–4778 (2021). https://doi.org/10.1007/s00464-020-07956-z

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  • DOI: https://doi.org/10.1007/s00464-020-07956-z

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