Aliyah Kanji, MD, Luke Funk, MD, MPH, Andrew Suzo, James Vargo, W. Scott Melvin, MD, Kyle A Perry, MD
The Ohio State University Wexner Medical Center
INTRODUCTION: The effectiveness of laparoscopic antireflux surgery in the obese population remains controversial. While Roux en Y gastric bypass may represent an attractive therapeutic option in many of these patients, others lack the requisite comorbid conditions or are not interested in this surgical approach. Laparoscopic Nissen fundoplication (LNF) is the gold standard surgical approach to reflux control, but data describing its effectiveness in obese patients are limited. We performed a retrospective review to compare reflux symptom control and proton pump inhibitor (PPI) cessation following LNF in obese and non-obese patients.
METHODS: A retrospective review of a prospectively collected database was conducted for patients undergoing LNF for GERD from August 2009 to June 2012. Patients were divided into two groups based on their BMI: non-obese (BMI<30 kg/m2) or obese (BMI ≥30 kg/m2). Initial post-operative follow-up data were collected in the clinic setting, and more distant follow-up was obtained by telephone questionnaire. Outcomes included reflux symptom scores, PPI use, and patient satisfaction. Reflux symptoms were assessed using validated GERD symptom and GERD health related quality of life (GERD-HRQL) questionnaires. Data are presented as incidence (%), mean ± SD, or median (range) as appropriate. Comparisons were made using Student’s t-test and Fisher’s exact test. A p value of <0.05 was considered statistically significant.
RESULTS: One hundred and fourteen patients underwent LNF during the study period. Of these, 53 (46.5%) patients were non-obese (BMI = 26.0±3.1kg/m2) and 61 (53.5%) were obese (BMI = 35.1± 3.5kg/m2). The mean patient age, gender, ASA classification, and baseline Demeester score did not differ between the 2 groups. Mean operative times were 100.2±27.9 minutes and 117.3±31.9 minutes in the non-obese and obese groups respectively (p=0.003). Fifty-eight percent of patients completed follow-up questionnaires at a median follow-up of 12 months (1.25-37). Baseline GERD symptom scores while on maximal medical therapy were 34.3±19.8 in non-obese patients compared to 43.8±16.3 in the obese group (p=0.03). At one month follow-up, symptom scores improved to 14.4±9.4 and 12.0±10.2 respectively (p=0.465), and remained low at 12 month follow-up: 11.3±11.0 in non-obese group and 15.1±21.5 in the obese group (p=0.421). Baseline GERD-HRQL scores averaged 27.1±14.5 in non-obese patients compared to 29.7±11.7 in obese patients (p=0.393). At 12 months follow-up, GERD-HQRL scores improved to 5.9±5.3 in the non-obese group compared to 5.3±4.7 in the obese group (p=0.628). At 12 months follow-up, 90% of non-obese patients were free of acid reducing medications compared to 75% in the obese group (p=0.199). At 12 months follow-up, 92% of non-obese patients and 94% of obese patients were satisfied with their surgery.
CONCLUSION: Laparoscopic Nissen fundoplication provides excellent symptom control for patients with GERD symptoms refractory to medical therapy. Despite more severe baseline heartburn scores and mildly increased operative times, obese patients in this series experienced equivalent symptom relief compared to non-obese patients for the first year following surgery. Long-term follow up studies are required to establish the durability of these results.
Session: Poster Presentation
Program Number: P260