Nabeel R Obeid, MD1, Maria Altieri, MD1, Jie Yang, PhD2, Jihye Park, MS2, Kristie Price, BS3, Andrew Bates, MD1, Aurora D Pryor, MD1. 1Stony Brook Medicine, Department of Surgery, 2Stony Brook University, Department of Applied Mathematics and Statistics, 3Stony Brook University, School of Medicine
INTRODUCTION: Little is known about the choice of operation performed for symptomatic recurrence of reflux disease after fundoplication. Both repeat fundoplication and conversion to Roux-en-Y gastric bypass (RYGB) have been shown to be safe and effective in this setting. We aimed to characterize the rates of different revisional procedures and to identify risk factors associated with failed fundoplication in the state of New York.
METHODS: Using a comprehensive state-wide database (SPARCS), we examined records for all patients 18 years or older who underwent fundoplication between 2000-2010. Patients who were lost to follow-up after 3 years were excluded. The primary outcomes were the rate of each type of reoperation and the pattern of subsequent procedures. Chi squared analyses were used to compare categorical variables. Demographics and comorbidities were used in a multivariable logistic regression model to identify risk factors associated with failure of primary fundoplication.
RESULTS: A total of 9,462 patients were included in the analysis. Overall, 430 (4.5%) patients underwent reoperation. Of those, only 46 (10.7%) patients were converted to RYGB at first reoperation, with the remainder having a revisional fundoplication (89.3%). An additional 5 patients (51 total) were eventually converted to RYGB after having undergone a revisional fundoplication (11.9% of patients with reoperation were converted to RYGB at any point). As expected, the majority of patients (83%) who underwent conversion to RYGB were obese, as opposed to only 8% for redo fundoplication patients. Table 1 illustrates the rates of each reoperation sequence. On average, any reoperation was performed 2.9 years after initial fundoplication. Redo fundoplication was performed at a mean of 2.5 years later, while patients were converted to RYGB at a mean of 6.5 years. After controlling for confounding variables, age 30-49 years (vs. > 70 years; OR 2.01, CI 1.31-3.14, p = 0.011) and 50-69 years (vs. > 70 years; OR 1.61, CI 1.08-2.44, p = 0.011), female gender (vs. male; OR 1.56, CI 1.26-1.93, p = < 0.0001), and chronic pulmonary disease (OR 1.40, CI 1.1-1.75, p = 0.0044) were associated with revisional surgery.
CONCLUSION: Fundoplication has a low rate of reoperation for recurrent symptoms within a mean of 8.3 years of index surgery. Revisional fundoplication is much more commonly performed than conversion to Roux-en-Y gastric bypass, and is performed much earlier after recurrence. Younger age, female gender, and chronic pulmonary disease are associated with symptomatic recurrence after fundoplication.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79403
Program Number: S097
Presentation Session: Foregut 2
Presentation Type: Podium
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