Hana Fayazzadeh, MD1, Christopher R Daigle, MD2, Raul J Rosenthal, MD3, Stacy A Brethauer, MD1, Philip R Schauer, MD1, Kevin M El-Hayek, MD1, Matthew Kroh, MD4. 1Cleveland Clinic, 2Cleveland Clinic Akron General, 3Cleveland Clinic Weston Florida, 4Cleveland Clinic Abu Dhabi
OBJECTIVE: Gastro-esophageal reflux disease (GERD) occurs in 20% of the adult population in the United States. Its incidence is increased in patients with higher Body Mass Index (BMI). The gold-standard anti-reflux option is laparoscopic fundoplication, however its effectiveness is reportedly less in patients with high BMI. We aim to describe long-term outcomes of primary fundoplication in obese patients at our institution.
METHODS: All patients with BMI ≥ 30 kg/m2 who underwent primary fundoplication between 2005 and 2015 were retrospectively studied. Pre-operative findings, surgical details, and long-term outcomes (follow-up time ≥ 6 months) are reported.
RESULTS: A total of 125 patients with medically refractory GERD who underwent primary Nissen (N=120) or Toupet (N=5) fundoplication were included. The mean age and BMI were 54.8±13.8 years and 33.3±3.4 kg/m2, respectively. Fundoplication was performed via laparoscopy in 86% (N=108). Mean operative time was 150.1±96 minutes, estimated blood loss was 42.4±49.8 ml, and duration of stay was 3.3±2.7 days. Mesh reinforcement was used in 24% of patients (N=30). During the post-operative period with mean follow up of 67.9±37.6 months, patients with BMIs 30-35 kg/m2, 35-40 kg/m2, and ≥ 40 kg/m2 reported recurrent symptoms 29% (N=26), 70% (N=19), and 50% (N=4) of the times, respectively. Follow up radiographic or endoscopic evaluations confirmed anatomical recurrence in 21% (N=19), 55% (N=15), and 38% (N=3) of the aforementioned BMI categories, respectively.
CONCLUSIONS: Primary fundoplication in obese population may not result in the satisfactory outcomes due to high BMI and other comorbid conditions. Weight loss interventions may improve the benefits in this specific population.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94945
Program Number: P630
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster
sages_adbutler_leaderboard