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Does BMI Predict Recurrence or Complications After Reoperative Reflux Surgery? Review of a Single Center’s Experience and a Comparison of Outcomes

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Obese patients who fail primary surgical management of gastroesophageal reflux present a significant challenge. We reviewed our outcomes with reoperative reflux surgery in obese (body mass index (BMI) >30) and nonobese patients to identify predictors of failure and complications and evaluate whether reoperative fundoplication is the ideal solution for obese patients.

Methods

We conducted a retrospective review of consecutive patients undergoing reoperation for failed anti-reflux surgery between 1994 and 2013. Medical record review identified preoperative, intraoperative, and postoperative characteristics. Short- and long-term outcomes for obese and nonobese patients were compared using descriptive statistics and logistic regression.

Results

One hundred and nine interventions were identified in 95 patients. Clinical characteristics were similar between obese and nonobese patients. Eighty-eight (83.8 %) patients underwent laparoscopic repair, 87 (79.8 %) of whom had a Nissen fundoplication. Obese patients were more likely to fail via a slipped wrap (64.7 vs. 40.0 %; p = 0.02). No differences were seen in short- or long-term symptomatic relief or major complications. In bivariate analysis, short-term outcomes were predicted by preoperative albumin <3.5 mg/dL (odds ratio (OR), 0.27 (confidence interval (CI), 0.08–0.96); p = 0.04) and laparoscopic conversion (OR, 0.19 (CI, 0.04–1.03); p = 0.05). Laparoscopic conversion was associated with major complications (OR, 7.33 (CI, 1.33–40.55); p = 0.02). BMI was a significant predictor for long-term outcome (p = 0.03) as a continuous variable in sensitivity analyses.

Conclusions

Obese patients with recurrence after failed anti-reflux operation may be safely treated with a repeat operation. Our data indicate no difference in outcomes for patients with BMI >30, underscoring the importance of preoperative discussion as to the best approach: reoperative fundoplication or a gastric bypass.

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Conflict of Interest

The authors have no disclosures relevant to this manuscript.

Author information

Authors and Affiliations

  1. Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA

    E. Wakeam

  2. Division of Thoracic Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, 02130, USA

    E. Wakeam, J. Wee, A. Lebenthal & R. Bueno

  3. Department of Surgery, University of Toronto, Toronto, Canada

    E. Wakeam

  4. Department of Chemistry and Chemical Biology, Northeastern University, Boston, MA, USA

    R. J. Gilbert

  5. Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA

    S. O. Ali

Authors
  1. E. Wakeam
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  2. J. Wee
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  3. A. Lebenthal
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  4. S. O. Ali
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  5. R. J. Gilbert
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  6. R. Bueno
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Corresponding author

Correspondence to E. Wakeam.

Appendices

Appendix 1

Table 7 Preoperative workup performed
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Appendix 2

Table 8 Sensitivity analyses
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Wakeam, E., Wee, J., Lebenthal, A. et al. Does BMI Predict Recurrence or Complications After Reoperative Reflux Surgery? Review of a Single Center’s Experience and a Comparison of Outcomes. J Gastrointest Surg 18, 1965–1973 (2014). https://doi.org/10.1007/s11605-014-2656-4

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  • DOI: https://doi.org/10.1007/s11605-014-2656-4

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