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Risk factors for adverse outcomes following paraesophageal hernia repair among obese patients

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Abstract

Background

Although obesity is an established risk factor for adverse outcomes after paraesophageal hernia repair (PEHR), many obese patients nonetheless receive PEHR. The purpose of this study was to explore risk factors for adverse outcomes of PEHR among this high-risk cohort. We hypothesized that obese patients may have other risk factors for adverse outcomes following PEHR.

Methods

A retrospective study of adult obese patients who underwent minimally invasive PEHR from 2017 to 2019 was performed. Patients were excluded for BMI < 30 or if they had concomitant bariatric surgery at time of PEHR. The primary outcome of interest was a composite adverse outcome (CAO) defined as having any of the four following outcomes after PEHR: persistent GERD > 30 d, persistent dysphagia > 30 d, recurrence, or reoperation. Chi-square and t-test analysis was used to compare demographic and clinical characteristics. Multivariable logistic regression analysis was used to evaluate independent predictors of CAO.

Results

In total, 139 patients met inclusion criteria with a median follow-up of 19.7 months (IQR 8.8–81). Among them, 51/139 (36.7%) patients had a CAO: 31/139 (22.4%) had persistent GERD, 20/139 (14.4%) had persistent dysphagia, 24/139 (17.3%) had recurrence, and 6/139 (4.3%) required reoperation. On unadjusted analysis, patients with a CAO were more likely to have a history of prior abdominal surgery (86.3% vs 70.5%, p = 0.04) and were less likely to have undergone a preoperative CT scan (27.5% vs 45.5%, p = 0.04). On multivariable analysis, previous abdominal surgery was independently associated with an increased likelihood of CAO whereas age and preoperative CT scan had a decreased likelihood of CAO.

Conclusions

Although there were adverse outcomes among obese patients, minimally invasive PEHR may be feasible in a subset of patients at specialized centers. These findings may help guide the appropriate selection of obese patients for PEHR.

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References

  1. Gordon C, Kang JY, Neild PJ, Maxwell JD (2004) Review article: the role of the hiatus hernia in gastro-oesophageal reflux disease. Aliment Pharmacol Ther 20:719–732

    Article  CAS  PubMed  Google Scholar 

  2. Anvari M, Bamehriz F (2006) Outcome of laparoscopic Nissen fundoplication in patients with body mass index ≥35. Surg Endosc 20:230-234. https://doi.org/10.1007/s00464-005-0031-y

    Article  CAS  PubMed  Google Scholar 

  3. Kulig M, Nocon M, Vieth M, Leodolter A, Jaspersen D, Labenz J, Meyer-Sabellek W, Stolte M, Lind T, Malfertheiner P, Willich SN (2004) Risk factors of gastroesophageal reflux disease: methodology and first epidemiological results of the ProGERD study. J Clin Epidemiol. https://doi.org/10.1016/j.jclinepi.2003.10.010

    Article  PubMed  Google Scholar 

  4. Locke GR, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ (1999) Risk factors associated with symptoms of gastroesophageal reflux. Am J Med. https://doi.org/10.1016/S0002-9343(99)00121-7

    Article  PubMed  Google Scholar 

  5. Morgenthal CB, Lin E, Shane MD, Hunter JG, Smith CD (2007) Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes. Surg Endosc 21:1978–1984. https://doi.org/10.1007/s00464-007-9490-7

    Article  PubMed  Google Scholar 

  6. Bakhos CT, Patel SP, Petrov RV, Abbas AES (2019) Management of paraesophageal hernia in the morbidly obese patient. Thorac Surg Clin 29:379–386

    Article  PubMed  Google Scholar 

  7. Andolfi C, Jalilvand A, Plana A, Fisichella PM (2016) Surgical treatment of paraesophageal hernias: a review. J Laparoendosc Adv Surg Tech 26:778–783

    Article  Google Scholar 

  8. Luketich JD, Nason KS, Christie NA, Pennathur A, Jobe BA, Landreneau RJ, Schuchert MJ (2010) Outcomes after a decade of laparoscopic giant paraesophageal hernia repair. J Thorac Cardiovasc Surg. https://doi.org/10.1016/j.jtcvs.2009.10.005

    Article  PubMed  Google Scholar 

  9. Ballian N, Luketich JD, Levy RM, Awais O, Winger D, Weksler B, Landreneau RJ, Nason KS (2013) A clinical prediction rule for perioperative mortality and major morbidity after laparoscopic giant paraesophageal hernia repair. J Thorac Cardiovasc Surg 145:721–729

    Article  PubMed  PubMed Central  Google Scholar 

  10. Wilson LJ, Ma W, Hirschowitz BI (1999) Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol. https://doi.org/10.1111/j.1572-0241.1999.01426.x

    Article  PubMed  Google Scholar 

  11. Kohn GP, Price RR, DeMeester SR, Zehetner J, Muensterer OJ, Awad Z, Mittal SK, Richardson WS, Stefanidis D, Fanelli RD, SAGES Guidelines Committee (2013) Guidelines for the management of hiatal hernia. Surg Endosc 27:4409–4428

    Article  PubMed  Google Scholar 

  12. Aly A, Munt J, Jamieson GG, Ludemann R, Devitt PG, Watson DI (2005) Laparoscopic repair of large hiatal hernias. Br J Surg 92:648–653. https://doi.org/10.1002/bjs.4916

    Article  CAS  PubMed  Google Scholar 

  13. Perez AR, Moncure AC, Rattner DW (2001) Obesity adversely affects the outcome of antireflux operations. Surg Endosc 15:986–989

    Article  CAS  PubMed  Google Scholar 

  14. Oelschlager BK, Pellegrini CA, Hunter JG, Brunt ML, Soper NJ, Sheppard BC, Polissar NL, Neradilek MB, Mitsumori LM, Rohrmann CA, Swanstrom LL (2011) Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter, prospective, randomized trial. J Am Coll Surg. https://doi.org/10.1016/j.jamcollsurg.2011.05.017

    Article  PubMed  Google Scholar 

  15. Oelschlager BK, Pellegrini CA, Hunter J, Soper N, Brunt M, Sheppard B, Jobe B, Polissar N, Mitsumori L, Nelson J, Swanstrom L (2006) Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg. https://doi.org/10.1097/01.sla.0000237759.42831.03

    Article  PubMed  PubMed Central  Google Scholar 

  16. Dallemagne B, Kohnen L, Perretta S, Weerts J, Markiewicz S, Jehaes C (2011) Laparoscopic repair of paraesophageal hernia: long-term follow-up reveals good clinical outcome despite high radiological recurrence rate. Ann Surg. https://doi.org/10.1097/SLA.0b013e3181ff44c0

    Article  PubMed  Google Scholar 

  17. Hashemi M, Peters JH, DeMeester TR, Huprich JE, Quek M, Hagen JA, Crookes PF, Theisen J, DeMeester SR, Sillin LF, Bremner CG (2000) Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate. J Am Coll Surg. https://doi.org/10.1016/s1072-7515(00)00260-x

    Article  PubMed  Google Scholar 

  18. Antiporda M, Veenstra B, Jackson C, Kandel P, Daniel Smith C, Bowers SP (2018) Laparoscopic repair of giant paraesophageal hernia: are there factors associated with anatomic recurrence? Surg Endosc. https://doi.org/10.1007/s00464-017-5770-z

    Article  PubMed  Google Scholar 

  19. Okabayashi K, Ashrafian H, Zacharakis E, Hasegawa H, Kitagawa Y, Athanasiou T, Darzi A (2014) Adhesions after abdominal surgery: a systematic review of the incidence, distribution and severity. Surg Today 44:405–420

    Article  PubMed  Google Scholar 

  20. Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, McGuire A, Lower AM, Hawthorn RJS, O’Brien F, Buchan S, Crowe AM (1999) Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet. https://doi.org/10.1016/S0140-6736(98)09337-4

    Article  PubMed  Google Scholar 

  21. van Goor H (2007) Consequences and complications of peritoneal adhesions. Colorectal Dis. https://doi.org/10.1111/j.1463-1318.2007.01358.x

    Article  PubMed  Google Scholar 

  22. Fornari F, Gurski RR, Navarini D, Thiesen V, Mestriner LHB, Madalosso CAS (2010) Clinical utility of endoscopy and barium swallow x-ray in the diagnosis of sliding hiatal hernia in morbidly obese patients: a study before and after gastric bypass. Obes Surg. https://doi.org/10.1007/s11695-009-9971-y

    Article  PubMed  Google Scholar 

  23. Lindström D, Azodi OS, Wladis A, Tønnesen H, Linder S, Nåsell H, Ponzer S, Adami J (2008) Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial. Ann Surg 248:739–745. https://doi.org/10.1097/SLA.0b013e3181889d0d

    Article  PubMed  Google Scholar 

  24. Slater BJ, Collings A, Dirks R, Gould JC, Qureshi AP, Juza R, Rodríguez-Luna MR, Wunker C, Kohn GP, Kothari S, Carslon E, Worrell S, Abou-Setta AM, Ansari MT, Athanasiadis DI, Daly S, Dimou F, Haskins IN, Hong J, Krishnan K, Lidor A, Litle V, Low D, Petrick A, Soriano IS, Thosani N, Tyberg A, Velanovich V, Vilallonga R, Marks JM (2023) Multi-society consensus conference and guideline on the treatment of gastroesophageal reflux disease (GERD). Surg Endosc. https://doi.org/10.1007/s00464-022-09817-3

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA

    Nithya Kanagasegar, Marco-Jose Rivero & Carolyn Vekstein

  2. Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA

    Christine E. Alvarado & Christopher W. Towe

  3. Division of General and Minimally Invasive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA

    Joshua L. Lyons & Jeffrey M. Marks

  4. The Ohio State University College of Medicine, Columbus, OH, 43210, USA

    Iris Levine

  5. Section of Thoracic Surgery, Department of Surgery, University of Arizona, Tucson, AZ, 85724, USA

    Stephanie G. Worrell

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  1. Nithya Kanagasegar
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Correspondence to Jeffrey M. Marks.

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Disclosures

Dr. Joshua L. Lyons reports that he is a consultant for Steris Endoscopy. Dr. Christopher W. Towe reports that he is a consultant for Zimmer Biomet and Atricure and is a grant recipient for Zimmer Biomet. Dr. Stephanie G. Worrell reports that she is a consultant for Intuitive and Bristol Myers Squibb. Dr. Jeffrey M. Marks reports that he is a consultant for Boston Scientific and Steris Endoscopy. None of these relationships have affected this manuscript or the accuracy of the data analysis. Nithya Kanagasegar, Dr. Christine Alvarado, Marco-Jose Rivero, Carolyn Vekstein, and Iris Levine have no conflicts of interest or financial ties to disclose.

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Kanagasegar, N., Alvarado, C.E., Lyons, J.L. et al. Risk factors for adverse outcomes following paraesophageal hernia repair among obese patients. Surg Endosc 37, 6791–6797 (2023). https://doi.org/10.1007/s00464-023-10115-9

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