Danni Lu, BS1, Maria Altieri, MD1, Jie Yang, PhD1, Nabeel Obeid, MD2, Donglei Yan, MS1, Konstantinos Spaniolas, MD1, Mark Talamini, MD, MBA1, Aurora Pryor, MD1. 1Stony Brook, 2Michigan Medicine
INTRODUCTION: The development of postsurgical gastroparesis following Nissen fundoplication is poorly understood. In this study, we analyze the development of gastroparesis requiring intervention and other subsequent procedures following fundoplication and paraesophageal hernia (PEH) repair procedures in the state of New York.
METHODS: Using a comprehensive state-wide administrative database (SPARCS), we examined all in-patient and out-patient records for adult patients who underwent fundoplication or PEH repair as a primary procedure for the treatment of GERD between the years of 2005-2010. Patients with an initial gastroparesis diagnosis were excluded from the analysis. Through the use of a unique identifier, each patient was followed until 2015 for the subsequent diagnosis of gastroparesis or reoperation. Surgical procedures for the treatment of gastroparesis included pyloroplasty, pyloromyotomy, or gastroenterostomy procedures. Multivariable logistic regression models were used to identify independent predictors for having subsequent reoperation.
RESULTS: A total of 6,438 patients were analyzed. This included 3,961 fundoplication patients (61.52%) and 2,477 (38.48%) with PEH repair. In the fundoplication group, 388 (9.80%) patients had a follow-up diagnosis of gastroparesis or secondary procedure. 211 (8.52%) of the patients who underwent a primary PEH repair procedure had a follow-up procedure or gastroparesis diagnosis (Table 1). Mean time to follow-up procedure or diagnosis was 2.81 years for the fundoplication group and 2.16 years for the PEH repair group. The majority of the follow-up procedures in the fundoplication group were revisional procedures (fundoplication or PEH repair) (n = 254, 6.41%), while 134 (3.38%) patients were newly diagnosed with gastroparesis and/or underwent a secondary procedure for its treatment. In the PEH repair group, 116 (4.68%) patients underwent subsequent PEH repair or fundoplication, while 95 (3.84%) were diagnosed or surgically treated for gastroparesis. In the fundoplication group, risk factors for having a follow-up procedure to treat gastroparesis included being female (OR = 1.423, 95% CI = 1.02-1.99), history of COPD (OR = 1.412, 95% CI = 1.01-1.97), and history of diabetes (OR = 1.857, 95% CI = 1.18-2.93). For the PEH repair group, risk factors for a follow-up procedure to treat gastroparesis included history of hypothyroidism (OR = 1.707, 95% CI = 1.09-2.67).
CONCLUSION: Fundoplication and PEH repair procedures have a relatively low post-operative incidence of gastroparesis following initial procedure for treatment of GERD. Secondary fundoplication or PEH repair was more commonly performed compared to any of the surgical procedures for gastroparesis for both procedures. Further analysis of association with subsequent procedures is needed.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87506
Program Number: P405
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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