Laparoscopic anti-reflux surgery is effective in obese patients with gastro-oesophageal reflux disease - PubMed (original) (raw)

Laparoscopic anti-reflux surgery is effective in obese patients with gastro-oesophageal reflux disease

Vivien V Ng et al. Ann R Coll Surg Engl. 2007 Oct.

Abstract

Introduction: Obesity has long been regarded as a risk factor for the development of gastro-oesophageal reflux disease (GORD). It has been claimed that surgical efficacy of laparoscopic anti-reflux operations is decreased in obese patients. The aim of this study was to assess whether laparoscopic anti-reflux surgery is effective in obese patients with GORD compared to non-obese patients.

Patients and methods: A total of 366 patients (mean age 44 years; range, 12-86 years) underwent laparoscopic anti-reflux surgery between 1997-2003. Of these, 74 patients were considered obese; 58 patients had a body mass index (BMI) of 30-34 kg/m(2) and 16 were classified as morbidly obese with a BMI >or= 35 kg/m(2). Pre-operative symptomatic scoring, indications for surgery, pH studies, operative times and complications were compared between obese and non-obese patients. Symptomatic outcome and Visick score between the two groups were assessed at 6 weeks, 6 months and 1 year following surgery.

Results: Failure of medical treatment was the main reason for surgery in all groups. Operative time was longer in obese patients (mean time 93 min compared to 81 min; P = 0.0007), the main difficulty being gaining access because of their body habitus. All groups found the procedure to be effective in symptomatic outcome, 91% of obese patients compared to 92% of non-obese patients scored Visick I or II at 6 weeks' postoperatively. Similar Visick scoring was shown between the two groups at 6 months and 1 year, and in the morbidly obese group.

Conclusions: The outcome of laparoscopic anti-reflux surgery is similar between obese and non-obese patients with no trend towards a worse outcome in the obese or morbidly obese. Obesity should not be seen as a contra-indication, although it may be more technically challenging in this group of patients. Good results can be achieved in obese patients.

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Figures

Figure 1

Figure 1

Distribution of patients with BMI ≥ 30 kg/m2 (n = 74).

Figure 2

Figure 2

Follow-up Visick scores at 6 weeks, 6 months and 1 year

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References

    1. Locke GR, 3rd, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ., 3rd Risk factors associated with symptoms of gastroesophageal reflux. Am J Med. 1999;106:642–9. - PubMed
    1. Wajed SA, Streets CG, Bremner CG, DeMeester TR. Elevated body mass disrupts the barrier to gastroesophageal reflux. Arch Surg. 2001;136:1014–8. discussion 1018–9. - PubMed
    1. Barak N, Ehrenpreis ED, Harrison JR, Sitrin MD. Gastro-esophageal reflux disease in obesity: pathophysiological and therapeutic considerations. Obes Rev. 2002;3:9–15. - PubMed
    1. Perez AR, Moncure AC, Rattner DW. Obesity adversely affects the outcome of antireflux operations. Surg Endosc. 2001;15:986–9. - PubMed
    1. Beauchamp G. Gastroesophageal reflux and obesity. Surg Clin North Am. 1983;63:869–76. - PubMed

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