Surgeons at the institution hypothesized that obesity was associated with long-term failure of antireflux procedures, and that in obese patients antireflux operations were easier to perform via thoracotomy, and therefore likely to have a greater success rate than transabdominal (laparoscopic or open) antireflux procedures.
To test if this was the case, the research team compared the success rates of transthoracic and laparoscopic approaches in obese patients with gastroesophageal reflux.
The records of consecutive patients undergoing antireflux surgery by 2 surgeons in a university-based tertiary care center were reviewed and patients contacted for follow-up evaluation.
The patients were classified into groups based on the type of operation performed, and their calculated body mass index (BMI).
A BMI of less than 25 was ranked as normal, while patients with a BMI of 25-29 were considered overweight and those with a BMI greater than 30 were classed as obese.
Recurrences were noted by responsiveness of symptoms to acid-suppressive medication and radiologic or pH probe studies.
Among the 224 patients included in the study, 187 underwent laparoscopic Nissen fundoplications (LNF) and 37 underwent Belsey Mark IV (BM4) procedures. The mean follow-up period was 37 months.
The 3 groups included 89 (40%) patients classified as having a normal weight, 87 (39%) as overweight, and 48 (21%) as obese.
All 3 groups of patients were similar in terms of age, gender, hiatal hernia size, degree of esophagitis, and comorbid complications.
A total of 26 recurrences occurred, giving an overall recurrence rate of 11.6%. There were 4 recurrences in the normal weight group (4.5%), 7 in the overweight group (8.0%), and 15 in the obese group (31%).
The recurrence rate was similar between LNF and BM4 in each BMI subgroup, although in aggregate, the recurrence rate after BM4 was greater than after LNF (10 patients out of 37 treated, compared to 16 out of 187, respectively).
|Obesity reduces the success of antireflux operations|
The research team concludes from their study that obesity adversely affects the long-term success of antireflux operations.
They add that although a thoracotomy provides optimal exposure of the hiatal structures in obese patients, a transthoracic approach is associated with a higher recurrence rate than LNF.
The report, to be published in the September issue of the journal Surgical Endoscopy ends by suggesting that given the high failure rate of antireflux operations in obese patients, intensive efforts at sustained weight loss should be made before consideration of surgery.