Preoperative Body Mass Index Predicts Two-Year Weight Loss Outcomes Following Laparoscopic Fundoplication

Lava Y Patel, MD1, Nicolas J Bonamici, BA1, Thomas J Stringer, BA1, Craig Brown, BS1, Joseph D Morrison, BS1, Matthew E Gitelis, BS1, Yalini Vigneswaran, MD2, Brittany Lapin, PhD1, John G Linn, MD1, Michael B Ujiki, MD1. 1NorthShore University HealthSystem, 2University of Chicago Pritzker School of Medicine

Introduction: Weight loss following laparoscopic fundoplication has been seen in patients in the immediate postoperative period.  To date, there is no way of predicting how a fundoplication procedure will affect the patient's weight status, if at all, in the long term.  Here we report the use of preoperative body mass index (BMI) as an assessment tool to predict long-term changes in weight following this procedure.

Methods: A retrospective review of a prospectively maintained database (n=615) at our institution was performed. In this study, 228 patients were identified as having undergone a laparoscopic fundoplication procedure for either GERD or PEH.  Transoral incisionless fundoplication patients were excluded as were any patients who had a redo operation or pyloroplasty during the same operation.   Patients were classified into four groups based upon BMI on the date of surgery: BMI<25 (n=56), BMI 25-30 (n=83), BMI 30-35 (n=63) and BMI>35 (n=26).  Weight change outcomes were measured postoperatively at three weeks (3WPO), 6 months (6MPO), one-year (1YPO), and two-years (2YPO). Comparisons between groups were made using one-way ANOVA, and adjusted linear regression models were constructed to predict weight loss at 2YPO.

Results: All data are presented as mean ± standard deviation unless otherwise stated and negative numbers indicate weight loss. Weight change at 2YPO was significantly different between the various BMI profiles (p<0.01): patients with BMI<25 gained 0.4 ± 10.6 lbs, BMI 25-30 lost -2.8 ± 13.7, BMI 30-35 lost -5.3 ± 16.3, and BMI >35 lost -16.9 ± 20.8.  A linear regression model showed that preoperative BMI could significantly predict postoperative weight change at 2YPO (estimate ± se: -1.01 ± 0.23, p<0.01).  The relationship between preoperative BMI and weight change remained intact after controlling for age and type of fundoplication (Nissen vs Toupet vs Dor).

Conclusions: Our findings suggest preoperative BMI is a contributing factor to weight change outcomes at two-years following laparoscopic fundoplication.  Morbidly obese patients tend to lose significantly more weight.

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