Obesity does not adversely affect the outcome of laparoscopic antireflux surgery (LARS).
ABSTRACT Because it has been suggested that obesity adversely affects the outcome of LARS, it is unclear how surgeons should counsel obese patients referred for antireflux surgery.
A prospective database of patients undergoing LARS from 1992 to 2001 was used to compare obese and nonobese patients. Patients were surveyed preoperatively and annually thereafter. Questionnaires were completed regarding global symptoms and overall satisfaction.
Of the 505 patients, the body mass index (BMI) was <25 (normal) in 16%, 25-29 (overweight) in 42%, and >30 (obese) in 42%. Although the operative time was longer in the obese group than in the normal weight group (137 +/- 55 min vs 115 +/- 42 min, p = 0.003), the time to discharge and rate of complications did not differ. At a mean follow-up of 35 +/- 25 months, there were no differences in symptoms, overall improvement, or patient satisfaction. Further, the rates of anatomic failure were similar among the obese, overweight, and normal weight groups.
Although the operative time is longer in the obese, complication and anatomic failure rates are similar to those in the nonobese at long-term follow-up. Obese patients have equivalent symptom relief and are equally satisfied postoperatively. Therefore, obesity should not be a contraindication to LARS.
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ABSTRACT: Fifty consecutive massively obese patients referred for gastroplasty operations were prospectively studied to determine the existence of gastroesophageal reflux disease by means of a standardized questionnaire, 24-hr ambulatory pH-metry, and endoscopy (27 females, mean age 48 years, range 38-57 years). These patients had a body mass index (BMI) of 42.5 +/- 5.2 kg/m2 and an actual weight of 125.5 +/- 17 kg. Heartburn and acid regurgitation was reported by 37% and 28%, respectively, mostly of a mild degree (22% and 20%). Dysphagia was reported by 2%, but none had odynophagia. No patient had any macroscopic esophagitis. The pH data were compared with those obtained in 29 age- and sex-matched, symptom-free, healthy controls (15 females, mean age 47.6 years, range 30-63 years). During ambulatory pH-metry, we recorded a predominance of daytime reflux (7.2 +/- 8.2% and total acid exposure of 5.3 +/- 6.4%) in the obese patients, but neither the weight, BMI, nor the waist-hip ratio were significantly correlated with any of the reflux variables. The pH data obtained from these patients did not, however, differ significantly from those recorded in the control population, although a somewhat lower daytime acid reflux was found in the latter group. These results suggest that massive overweight is not associated with an increased prevalence of gastroesophageal reflux disease.Digestive Diseases and Sciences 09/1995; 40(8):1632-5. · 2.26 Impact Factor
- Surgical Endoscopy 06/1999; 13(5):542. · 3.43 Impact Factor
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ABSTRACT: Chronic (obesity) and acute intraabdominal pressure increases appear to favor gastroesophageal reflux, but the mechanism is not completely understood. We hypothesized that it could be due to an alteration in the resistance gradient between the stomach and the gastroesophageal junction, even increasing intragastric resistance above resistance at the gastroesophageal junction. Hence, we used a pneumatic resistometer to measure gastric and gastroesophageal resistance to flow in 11 lean healthy controls and eight morbidly obese individuals without gastroesophageal reflux disease. Resistance was quantified at rest and during acute intraabdominal pressure increases, both in the recumbent and sitting positions. We found that gastroesophageal junction resistance was higher than gastric resistance in lean as well as in obese subjects (P less than 0.001). In obese individuals both gastric and gastroesophageal junction resistance were increased (P less than 0.001), thus a normal gastric-gastroesophageal junction resistance gradient was maintained. Body position did not modify resistance. Acute increases in intraabdominal pressure decreased the gastric-gastroesophageal junction resistance gradient similarly in obese and lean subjects. We conclude that obesity by itself does not appear to predispose to gastroesophageal reflux, but it creates intraabdominal conditions that may favor reflux whenever the gastroesophageal barrier becomes weakened.Digestive Diseases and Sciences 11/1991; 36(10):1473-80. · 2.26 Impact Factor