Is laparoscopic antireflux surgery safe and effective in obese patients?

BACKGROUND

It is not clear whether obesity has any negative impact on the results of laparoscopic antireflux surgery (LARS). In this prospective study we investigated the effect of body mass index (BMI) on the surgical outcome of LARS.

METHODS

Patients undergoing primary LARS were divided into three groups: BMI < 25 (normal), BMI = 25-29.9 (overweight), BMI > 30 (obese). All perioperative data, operative and postoperative complications, and follow-up data were recorded prospectively. All patients were seen 2 months postoperatively and yearly thereafter.

RESULTS

One thousand patients underwent LARS from May 2004 to August 2009. There were 484, 384, and 132 patients in normal, overweight, and obese groups, respectively. The incidence of Barrett's metaplasia (8.5% for the entire series) increased with BMI, although this difference was not statistically significant. 684 patients had Nissen and 316 had Toupet fundoplication. Mean follow-up was 53.33 ± 17.21 months. There was no mortality or conversion to open surgery. Mean operating times were 48.04 ± 21.20, 53.54 ± 23.42, and 61.33 ± 28.47 min for normal, overweight, and obese groups, respectively (P = 0.0001). Esophageal perforation, jejunal perforation, and pulmonary emboli were the three major complications in separate patients. Dysphagia occurred in 18.4, 13.1, and 9.9% of normal, overweight, and obese patients, respectively (P = 0.122). Bloating occurred in 18, 14.1, and 20.5 % of normal, overweight, and obese patients, respectively (P = 0.150). Rehospitalization for any reason, excluding redo surgery or dilatation, occurred less in overweight subjects (4.8, 1, and 3.8% respectively, P = 0.008). All other minor complications were distributed evenly among the groups with the exception of hiccups, which occurred more frequently in normal weight patients. Recurrence of reflux was observed in 0.6, 3.6, and 2.3% of the normal, overweight, and obese patients, respectively (P = 0.007).

CONCLUSION

LARS is a safe but more demanding procedure in obese patients and a significant increase in complications should not be anticipated. Long-term control of reflux by LARS in higher-BMI patients is slightly worse than that in normal-weight subjects.