Operative Morbidity Increases With Body Mass Index In Antireflux Surgery

Michael B Goldberg, MD¹, Radhika Smith, MD¹, Colleen Gaughan, MD², Huaqing Zhao, PhD¹, Michael Smith, MD¹, Henry Parkman, MD¹, Daniel T Dempsey, MD³, Abbas E Abbas, MD¹. ¹Temple University Hospital, ²Abington Memorial Hospital, ³Hospital of the University of Pennsylvania

Purpose – Minimally invasive esophageal fundoplication is a well-established treatment for medically refractory gastroesophageal reflux disease (GERD), although its safety and efficacy in obese patients is debated. It is uncertain whether a greater body mass index (BMI) portends increased complications or inferior symptom relief postoperatively. In this study, we describe the effect of BMI on outcomes following minimally invasive antireflux surgery.

Methods – All patients who underwent minimally invasive surgery for GERD from 2003-2013 at a single institution were retrospectively reviewed. Data was collected on patient demographics, comorbid conditions, preoperative symptoms, operative characteristics, complications, and follow up.

Results – 176 patients underwent laparoscopic (169) and robotic (6) Nissen (119), Toupet (47), and Dor (12) fundoplications for a primary diagnosis of GERD. Of these patients, 21% (37) were normal weight (BMI 16.1-25), 36% (64) were overweight (BMI 25-29), and 43% (75) were obese (BMI 29-47.2). There was no difference in operative time, conversion to open surgery, length of stay, time to oral diet, operative complications, or postoperative morbidity among these groups. However, when using logistic regression analysis controlled for age and relevant comorbidities, each 1-unit increase in BMI predicted a 9.5% increased risk of morbidity at 30 days (p=0.035). BMI did not impact postoperative symptoms or acid suppression medication usage at long-term follow-up (mean=70 weeks).

Conclusions – Increased BMI is associated with a statistically significant increased risk of morbidity at 30 days after MIF. Despite this, long-term efficacy is not different. Obese patients with GERD must be carefully selected for esophageal fundoplication and actively monitored for postoperative complications.