Obesity does not adversely affect the outcome of laparoscopic antireflux surgery (LARS)

  • E. R. Winslow
  • M. M. Frisella
  • N. J. Soper
  • M. E. Klingensmith
Original article

Abstract

Background: Because it has been suggested that obesity adversely affects the outcome of LARS, it is unclear how surgeons should counsel obese patients referred for antireflux surgery. Methods: A prospective database of patients undergoing LARS from 1992 to 2001 was used to compare obese and nonobese patients. Patients were surveyed preoperatively and annually thereafter. Questionnaires were completed regarding global symptoms and overall satisfaction. Results: Of the 505 patients, the body mass index (BMI) was <25 (normal) in 16%, 25–29 (overweight) in 42%, and >30 (obese) in 42%. Although the operative time was longer in the obese group than in the normal weight group (137 ± 55 min vs 115 ± 42 min, p = 0.003), the time to discharge and rate of complications did not differ. At a mean follow-up of 35 ± 25 months, there were no differences in symptoms, overall improvement, or patient satisfaction. Further, the rates of anatomic failure were similar among the obese, overweight, and normal weight groups. Conclusions: Although the operative time is longer in the obese, complication and anatomic failure rates are similar to those in the nonobese at long-term follow-up. Obese patients have equivalent symptom relief and are equally satisfied postoperatively. Therefore, obesity should not be a contraindication to LARS.

Keywords

Obesity Gastroesophageal reflux disease Nissen fundoplication Surgical outcomes 

Notes

Acknowledgements

The authors acknowledge the support of the Washington University Institute of Minimally Invasive Surgery for this project.

References

  1. 1.
    Beauchamp, G 1983Gastroesophageal reflux and obesity.Surg Clin North Am63869876Google Scholar
  2. 2.
    Blachar, A, Federle, MP, Pealer, KM, Ikramuddin, S, Schauer, PR 2002Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings.Radiology223625632PubMedGoogle Scholar
  3. 3.
    Campos, GM, Peters, JH, DeMeester, TR, Oberg, S, Crookes, PF, Tan, S, DeMeester, SR, Hagen, JA, Bremner, CG 1999Multivariate analysis of factors predicting outcome after laparoscopic Nissen fundoplication.J Gastrointest Surg3292300CrossRefPubMedGoogle Scholar
  4. 4.
    Clavien, PA, Sanabria, JR, Strasberg, SM 1992Proposed classification of complications of surgery with examples of utility in cholecystectomy.Surgery111518526PubMedGoogle Scholar
  5. 5.
    Fisher, BL, Pennathur, A, Mutnick, JL, Little, AG 1999Obesity correlates with gastroesophageal reflux.Dig Dis Sci4422902294PubMedGoogle Scholar
  6. 6.
    Fraser, J, Watson, DI, O’Boyle, CJ, Jamieson, GG 2001Obesity and its effect on outcome of laparoscopic Nissen fundoplication.Dis Esophagus145053CrossRefPubMedGoogle Scholar
  7. 7.
    Fraser-Moodie, CA, Norton, B, Gornall, C, Magnago, S, Weale, AR, Holmes, GK 1999Weight loss has an independent beneficial effect on symptoms of gastro-oesophageal reflux in patients who are overweight.Scand J Gastroenterol34337340CrossRefPubMedGoogle Scholar
  8. 8.
    Frezza, EE, Ikramuddin, S, Gourash, W, Rakitt, T, Kingston, A, Luketich, J, Schauer, P 2002Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass.Surg Endosc1610271031CrossRefPubMedGoogle Scholar
  9. 9.
    Hagen, J, Deitel, M, Khanna, RK, Ilves, R 1987Gastroesophageal reflux in the massively obese.Int Surg7213PubMedGoogle Scholar
  10. 10.
    Hahnloser, D, Schumacher, M, Cavin, R, Cosendey, B, Petropoulos, P 2002Risk factors for complications of laparoscopic Nissen fundoplication.Surg Endosc164347CrossRefPubMedGoogle Scholar
  11. 11.
    Health, NIo 1998Clinical Guidelines of the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report.Obes Res651S209SPubMedGoogle Scholar
  12. 12.
    Hunter, JG, Trus, TL, Branum, GD, Waring, JP, Wood, WC 1996A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease.Ann Surg223673685discussion 685–677PubMedGoogle Scholar
  13. 13.
    Jones, KB, Alien, TV, Manas, KJ, McGinty, DP, Wilder, WM, Wadsworth, ED 1991Roux-Y gastric bypass: an effective anti-reflux procedure.Obes Surg1295298CrossRefPubMedGoogle Scholar
  14. 14.
    Jones Jr, KB 1998Roux-en-Y gastric bypass: an effective antireflux procedure in the less than morbidly obese.Obes Surg83538PubMedGoogle Scholar
  15. 15.
    Kjellin, A, Ramel, S, Rossner, S, Thor, K 1996Gastroesophageal reflux in obese patients is not reduced by weight reduction.Scand J Gastroenterol3110471051PubMedGoogle Scholar
  16. 16.
    Lagergren, J, Bergstrom, R, Nyren, O 2000No relation between body mass and gastro-oesophageal reflux symptoms in a Swedish population based study.Gut472629CrossRefPubMedGoogle Scholar
  17. 17.
    Locke, GRr, Talley, NJ, Fett, SL, Zinsmeister, AR, Melton Jr, L 1999Risk factors associated with symptoms of gastroesophageal reflux.Am J Med106642649PubMedGoogle Scholar
  18. 18.
    Lundell, L, Ruth, M, Sandberg, N, Bove-Nielsen, M 1995Does massive obesity promote abnormal gastroesophageal reflux?Dig Dis Sci4016321635PubMedGoogle Scholar
  19. 19.
    McNatt, SS SD, Hunter, JG, Galloway, JG 2000Morbid obesity does not predict a poor outcome after laparoscopic antireflux surgery.Gastroenterology118A1033(abstract)Google Scholar
  20. 20.
    O’Brien Jr, TF 1980Lower esophageal sphincter pressure (LESP) and esophageal function in obese humans.J Clin Gastroenterol2145148PubMedGoogle Scholar
  21. 21.
    Perez, AR MA, Rattner, DW 1999Obesity is a major cause of failure for both abdominal and transthoracic antireflux operations.Gastroenterology116A1343(abstract)Google Scholar
  22. 22.
    Perez, AR, Moncure, AC, Rattner, DW 2001Obesity adversely affects the outcome of antireflux operations.Surg Endosc15986989PubMedGoogle Scholar
  23. 23.
    Reardon, PR, Matthews, BD, Scarborough, TK, Preciado, A, Marti, JL, Brunicardi, FC 1999Techniques for omental retraction during laparoscopic nissen fundoplication.Surg Endosc13542CrossRefPubMedGoogle Scholar
  24. 24.
    Ruhl, CE, Everhart, JE 1999Overweight, but not high dietary fat intake, increases risk of gastroesophageal reflux disease hospitalization: the NHANES I Epidemiologic Followup Study. First National Health and Nutrition Examination Survey.Ann Epidemiol9424435CrossRefPubMedGoogle Scholar
  25. 25.
    Smith, SC, Edwards, CB, Goodman, GN 1997Symptomatic and clinical improvement in morbidly obese patients with gastroesophageal reflux disease following Roux-en-Y gastric bypass.Obes Surg7479484PubMedGoogle Scholar
  26. 26.
    Soper, NJ DD 1999Anatomic fundoplication failure after laparoscopic antireflux surgery.Ann Surg229669677PubMedGoogle Scholar
  27. 27.
    Steyaert, H, Al Mohaidly, M, Lembo, M, Carfagna, L, Tursini, S, Valla, J 2003Long-term outcome of laparoscopic Nissen and Toupet fundoplication in normal and neurologically impaired children.Surg Endosc17CrossRefPubMedGoogle Scholar
  28. 28.
    Wajed, SA, Streets, CG, Bremner, CG, DeMeester, TR 2001Elevated body mass disrupts the barrier to gastroesophageal reflux; discussion 1018–1019.Arch Surg13610141018CrossRefPubMedGoogle Scholar
  29. 29.
    Zacchi, P, Mearin, F, Humbert, P, Formiguera, X, Malagelada, JR 1991Effect of obesity on gastroesophageal resistance to flow in man.Dig Dis Sci3614731480PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • E. R. Winslow
    • 1
  • M. M. Frisella
    • 1
  • N. J. Soper
    • 1
  • M. E. Klingensmith
    • 1
  1. 1.Department of SurgeryWashington University School of Medicine, Box 8109, St. Louis, MO 63110USA

Personalised recommendations