Does BMI predict recurrence or complications after reoperative reflux surgery? Review of a single center's experience and a comparison of outcomes

J Gastrointest Surg. 2014 Nov;18(11):1965-73. doi: 10.1007/s11605-014-2656-4. Epub 2014 Sep 17.

Abstract

Introduction: Obese patients who fail primary surgical management of gastroesophageal reflux present a significant challenge. We reviewed our outcomes with reoperative reflux surgery in obese (body mass index (BMI) >30) and nonobese patients to identify predictors of failure and complications and evaluate whether reoperative fundoplication is the ideal solution for obese patients.

Methods: We conducted a retrospective review of consecutive patients undergoing reoperation for failed anti-reflux surgery between 1994 and 2013. Medical record review identified preoperative, intraoperative, and postoperative characteristics. Short- and long-term outcomes for obese and nonobese patients were compared using descriptive statistics and logistic regression.

Results: One hundred and nine interventions were identified in 95 patients. Clinical characteristics were similar between obese and nonobese patients. Eighty-eight (83.8%) patients underwent laparoscopic repair, 87 (79.8%) of whom had a Nissen fundoplication. Obese patients were more likely to fail via a slipped wrap (64.7 vs. 40.0%; p = 0.02). No differences were seen in short- or long-term symptomatic relief or major complications. In bivariate analysis, short-term outcomes were predicted by preoperative albumin <3.5 mg/dL (odds ratio (OR), 0.27 (confidence interval (CI), 0.08-0.96); p = 0.04) and laparoscopic conversion (OR, 0.19 (CI, 0.04-1.03); p = 0.05). Laparoscopic conversion was associated with major complications (OR, 7.33 (CI, 1.33-40.55); p = 0.02). BMI was a significant predictor for long-term outcome (p = 0.03) as a continuous variable in sensitivity analyses.

Conclusions: Obese patients with recurrence after failed anti-reflux operation may be safely treated with a repeat operation. Our data indicate no difference in outcomes for patients with BMI >30, underscoring the importance of preoperative discussion as to the best approach: reoperative fundoplication or a gastric bypass.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Body Mass Index*
  • Cohort Studies
  • Confidence Intervals
  • Female
  • Follow-Up Studies
  • Fundoplication / adverse effects*
  • Fundoplication / methods
  • Gastroesophageal Reflux / complications
  • Gastroesophageal Reflux / diagnosis
  • Gastroesophageal Reflux / surgery*
  • Humans
  • Male
  • Middle Aged
  • Obesity / complications
  • Obesity / diagnosis*
  • Obesity / surgery
  • Odds Ratio
  • Postoperative Care
  • Postoperative Complications / physiopathology
  • Postoperative Complications / surgery
  • Predictive Value of Tests
  • Preoperative Care / methods
  • Recurrence
  • Reoperation / adverse effects
  • Reoperation / methods
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Treatment Outcome