Advertisement

Surgical Endoscopy

, Volume 34, Issue 2, pp 646–657 | Cite as

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

  • Zachary Sanford
  • Shyam Jayaraman
  • Adam S. Weltz
  • H. Reza Zahiri
  • Adrian ParkEmail author
Article
  • 91 Downloads

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.

Keywords

Obesity Body mass index BMI Laparoscopic anti-reflux surgery LARS Quality of life outcomes QOL Gastroesophageal reflux disease GERD 

Notes

Acknowledgement

Copy editing and review services provided by Elizabeth Lewis.

Compliance with ethical standards

Disclosures

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.

Informed Consent

All authors certify that they accept responsibility as an author and have contributed to the concept, data gathering, analysis, manuscript drafting, and give their final approval.

References

  1. 1.
    Nam SY (2017) Obesity-Related Digestive Diseases and Their Pathophysiology. Gut Liver. 11(3):323–334CrossRefGoogle Scholar
  2. 2.
    Djalalinia S, Qorbani M, Peykari N, Kelishadi R (2015) Health impacts of Obesity. Pak J Med Sci 31(1):239–242PubMedPubMedCentralGoogle Scholar
  3. 3.
    Pompili M, Forte A, Lester D et al (2014) Suicide risk in type 1 diabetes mellitus: a systematic review. J Psychosom Res 76(5):352–360CrossRefGoogle Scholar
  4. 4.
    Wang Y, Tang S, Xu S, Weng S, Liu Z (2016) Association between diabetes and risk of suicide death: a meta-analysis of 3 million participants. Compr Psychiatry 71:11–16CrossRefGoogle Scholar
  5. 5.
    El-Serag HB, Sweet S, Winchester CC, Dent J (2014) Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 63(6):871–880CrossRefGoogle Scholar
  6. 6.
    Moore M, Afaneh C, Benhuri D, Antonacci C, Abelson J, Zarnegar R (2016) Gastroesophageal reflux disease: a review of surgical decision making. World J Gastrointest Surg. 8(1):77–83CrossRefGoogle Scholar
  7. 7.
    Heidelbaugh JJ, Gill AS, Van Harrison R, Nostrant TT (2008) Atypical presentations of gastroesophageal reflux disease. Am Fam Physician 78(4):483–488PubMedGoogle Scholar
  8. 8.
    Lee YS, Jang BH, Ko SG, Chae Y (2018) Comorbid risks of psychological disorders and gastroesophageal reflux disorder using the national health insurance service-National Sample Cohort: a STROBE-compliant article. Medicine (Baltimore). 97(18):e0153CrossRefGoogle Scholar
  9. 9.
    Chen X, Li P, Wang F, Ji G, Miao L, You S (2017) Psychological results of 438 patients with persisting gastroesophageal reflux disease symptoms by symptom checklist 90-revised questionnaire. Euroasian J Hepatogastroenterol 7(2):117–121CrossRefGoogle Scholar
  10. 10.
    Weltz AS, Zahiri HR, Sibia US, Wu N, Fantry GT, Park AE (2017) Patients are well served by Collis gastroplasty when indicated. Surgery. 162(3):568–576CrossRefGoogle Scholar
  11. 11.
    Park AE, Hoogerboord CM, Sutton E (2012) Use of the falciform ligament flap for closure of the esophageal hiatus in giant paraesophageal hernia. J Gastrointest Surg. 16(7):1417–1421CrossRefGoogle Scholar
  12. 12.
    Belafsky PC, Postma GN, Koufman JA (2002) Validity and reliability of the reflux symptom index (RSI). J Voice 16(2):274–277CrossRefGoogle Scholar
  13. 13.
    Velanovich V (2007) The development of the GERD-HRQL symptom severity instrument. Dis Esophagus 20(2):130–134CrossRefGoogle Scholar
  14. 14.
    Carrau RL, Khidr A, Gold KF et al (2005) Validation of a quality-of-life instrument for laryngopharyngeal reflux. Arch Otolaryngol Head Neck Surg 131(4):315–320CrossRefGoogle Scholar
  15. 15.
    McHorney CA, Robbins J, Lomax K et al (2002) The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity. Dysphagia 17(2):97–114PubMedGoogle Scholar
  16. 16.
    El-Serag H (2008) The association between obesity and GERD: a review of the epidemiological evidence. Dig Dis Sci 53(9):2307–2312CrossRefGoogle Scholar
  17. 17.
    El-Serag HB, Graham DY, Satia JA, Rabeneck L (2005) Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol 100(6):1243–1250CrossRefGoogle Scholar
  18. 18.
    Chang P, Friedenberg F (2014) Obesity and GERD. Gastroenterol Clin North Am 43(1):161–173CrossRefGoogle Scholar
  19. 19.
    Fujimoto A, Hoteya S, Iizuka T et al (2013) Obesity and gastrointestinal diseases. Gastroenterol Res Pract. 2013:760574CrossRefGoogle Scholar
  20. 20.
    Adams KF, Schatzkin A, Harris TB et al (2006) Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med 355(8):763–778CrossRefGoogle Scholar
  21. 21.
    Anggiansah R, Sweis R, Anggiansah A, Wong T, Cooper D, Fox M (2013) The effects of obesity on oesophageal function, acid exposure and the symptoms of gastro-oesophageal reflux disease. Aliment Pharmacol Ther 37(5):555–563CrossRefGoogle Scholar
  22. 22.
    Ayazi S, Hagen JA, Chan LS et al (2009) Obesity and gastroesophageal reflux: quantifying the association between body mass index, esophageal acid exposure, and lower esophageal sphincter status in a large series of patients with reflux symptoms. J Gastrointest Surg. 13(8):1440–1447CrossRefGoogle Scholar
  23. 23.
    O’Donnell FL, Taubman SB (2016) Incidence of hiatal hernia in service members, active component, U.S. Armed Forces, 2005-2014. MSMR, 23(8):11–15Google Scholar
  24. 24.
    Che F, Nguyen B, Cohen A, Nguyen NT (2013) Prevalence of hiatal hernia in the morbidly obese. Surg Obes Relat Dis 9(6):920–924CrossRefGoogle Scholar
  25. 25.
    Petersen H, Johannessen T, Sandvik AK et al (1991) Relationship between endoscopic hiatus hernia and gastroesophageal reflux symptoms. Scand J Gastroenterol 26(9):921–926CrossRefGoogle Scholar
  26. 26.
    Menon S, Trudgill N (2011) Risk factors in the aetiology of hiatus hernia: a meta-analysis. Eur J Gastroenterol Hepatol 23(2):133–138CrossRefGoogle Scholar
  27. 27.
    Anvari M, Bamehriz F (2006) Outcome of laparoscopic Nissen fundoplication in patients with body mass index > or = 35. Surg Endosc 20(2):230–234CrossRefGoogle Scholar
  28. 28.
    Chisholm JA, Jamieson GG, Lally CJ, Devitt PG, Game PA, Watson DI (2009) The effect of obesity on the outcome of laparoscopic antireflux surgery. J Gastrointest Surg. 13(6):1064–1070CrossRefGoogle Scholar
  29. 29.
    D’Alessio MJ, Arnaoutakis D, Giarelli N, Villadolid DV, Rosemurgy AS (2005) Obesity is not a contraindication to laparoscopic nissen fundoplication. Journal of Gastrointestinal Surgery. 9(7):949–954CrossRefGoogle Scholar
  30. 30.
    Luketina RR, Koch OO, Kohler G, Antoniou SA, Emmanuel K, Pointner R (2015) Obesity does not affect the outcome of laparoscopic antireflux surgery. Surg Endosc 29(6):1327–1333CrossRefGoogle Scholar
  31. 31.
    Ng VV, Booth MI, Stratford JJ, Jones L, Sohanpal J, Dehn TC (2007) Laparoscopic anti-reflux surgery is effective in obese patients with gastro-oesophageal reflux disease. Ann R Coll Surg Engl 89(7):696–702CrossRefGoogle Scholar
  32. 32.
    Winslow ER, Frisella MM, Soper NJ, Klingensmith ME (2003) Obesity does not adversely affect the outcome of laparoscopic antireflux surgery (LARS). Surg Endosc 17(12):2003–2011CrossRefGoogle Scholar
  33. 33.
    Fraser J, Watson DI, O’Boyle CJ, Jamieson GG (2001) Obesity and its effect on outcome of laparoscopic Nissen fundoplication. Dis Esophagus 14(1):50–53CrossRefGoogle Scholar
  34. 34.
    Abdelrahman T, Latif A, Chan DS et al (2018) Outcomes after laparoscopic anti-reflux surgery related to obesity: a systematic review and meta-analysis. Int J Surg. 51:76–82CrossRefGoogle Scholar
  35. 35.
    Bashir Y, Chonchubhair HN, Duggan SN, et al (2018) Systematic review and meta-analysis on the effect of obesity on recurrence after laparoscopic anti-reflux surgery. Surgeon, 7Google Scholar
  36. 36.
    Schietroma M, Piccione F, Clementi M et al (2017) Short- and Long-Term, 11-22 Years, Results after Laparoscopic Nissen Fundoplication in Obese versus Nonobese Patients. J Obes. 2017:7589408CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Zachary Sanford
    • 1
  • Shyam Jayaraman
    • 1
  • Adam S. Weltz
    • 1
  • H. Reza Zahiri
    • 1
  • Adrian Park
    • 1
    • 2
    Email author
  1. 1.Department of SurgeryAnne Arundel Medical CenterAnnapolisUSA
  2. 2.Department of SurgeryJohns Hopkins University School of MedicineBaltimoreUSA

Personalised recommendations