Semeret T Munie, MD, Melissa C Helm, MS, Jon C Gould, MD, Andrew Kastenmeier, MD, Tammy L Kindel, MD, PhD. Medical College of Wisconsin
Background: Achalasia in the setting of morbid obesity is a unique surgical challenge as use of standard surgical therapy with a laparoscopic Heller myotomy (HM) carries a high likelihood of further postoperative weight gain and worsening of obesity-associated comorbidities. Concomitant treatment of achalasia and morbid obesity is an attractive consideration but with limited evidence in the literature beyond case reports to suggest an acceptable safety profile regarding perioperative outcomes in this high-risk patient population. The aim of this study was to compare the 30-day postoperative complication rate in patients who underwent concurrent laparoscopic Roux-en-Y gastric bypass (RYGB) and HM to those who underwent RYGB alone.
Methods: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) 2015 and 2016 datasets were queried for primary laparoscopic RYGB and concurrent RYGB with HM. A case-control matching was performed for age, BMI and ASA class to obtain a 1:2 matching ratio between concurrent RYGB-HM and RYBG alone patients, respectively. Analysis was performed comparing 30-day post-operative outcomes of the two groups.
Results: There were 65,504 primary laparoscopic RYGB procedures, with 62 RYGB patients matched to 31 RYGB-HM patients. Importantly, there were no reported mortalities and no significant differences in the rate of reoperation (1.60% vs 3.20%, p=0.19), interventions (3.2% vs 3.2%, p=1.00) or readmissions (3.20% vs 9.70%, p=0.19) between RYGB vs. RYGB-HM groups. There was also no difference in the rate of post-operative pneumonias (1.60% vs 0%, p=0.48), need for blood transfusion (1.60% vs 3.20%, p=0.61) and no VTE occurrences in either group. Although the operative time was longer with concurrent RYGB-HM compared to RYGB alone by 58 minutes (p<0.01), there was no difference in hospital length of stay (2 ± 1.3 vs 2.06 ± 0.9 days, p=0.78).
Conclusion: In this matched case-control study utilizing the MBSQIP database, we found that concurrent RYGB-HM is as safe as primary RYGB. This is the largest reported study documenting the safety of concurrent RYGB-HM in patients with achalasia and morbid obesity suggesting both diseases can be treated simultaneously with exceptional 30-day safety in MBSAQIP accredited centers.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95641
Program Number: P127
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster