Obesity does not adversely affect the outcome of laparoscopic antireflux surgery (LARS). Surg Endosc

Department of Surgery, Washington University School of Medicine, Box 8109, St. Louis, MO 63110, USA.
Surgical Endoscopy (Impact Factor: 3.26). 12/2003; 17(12):2003-11. DOI: 10.1007/s00464-003-8118-9
Source: PubMed


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.

7 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background The influence of obesity on the outcome of laparoscopic fundoplication is yet to be determined. Furthermore, results of fundoplication in Japanese patients have not been reported. Accordingly, we examined whether obesity affects the outcome of laparoscopic fundoplication in Japanese patients. Methods We examined 145 patients who underwent laparoscopic fundoplication for erosive reflux esophagitis. The patients were classified into three groups by body mass index (BMI) (group A, BMI < 25; group B, BMI = 25–30; group C, BMI ≥ 30). Preoperative conditions by anatomy-function-pathology (AFP) classification, surgical procedure, duration of operation, complications, blood loss, postoperative stay, and recurrence of esophagitis were compared. Results Average BMI was 22.1 in group A, 26.5 in group B, and 31.7 in group C. There were no significant differences between preoperative pathophysiology and surgical methods, but there were in P factor, by AFP classification. Duration of operation was significantly longer in group C (P = 0.0309). There were no differences in blood loss, complications, and postoperative recurrence among the groups. Conclusions The results of laparoscopic fundoplication in Japanese patients were not affected by BMI.
    No preview · Article · Dec 2009 · Esophagus
  • [Show abstract] [Hide abstract]
    ABSTRACT: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been proven effective against gastroesophageal reflux disease (GERD) in morbidly obese patients. We present our experience with revision of antireflux procedures to LRYGBP in obese patients with recurrent GERD, weight gain or a combination of both and discuss the indications and technical considerations involved. Between June 2000 and December 2003, 7 morbidly obese patients with a mean BMI of 37.5 kg/m(2) underwent revision of an antireflux procedure to LRYGBP by our group. Important steps of the revision include dissection of the diaphragmatic crura and gastroesophageal fat pad, reduction and repair of hiatal hernia, and complete take-down of the wrap to avoid stapling over the fundoplication which can create an obstructed, septated pouch. Mean operative time was 6 hr 12 min and length of stay was 4.8 days. There were 3 major complications postoperatively and no deaths. During follow-up, 5 patients developed anastomotic strictures and 2 patients were re-explored for gastric remnant herniation and intestinal obstruction. At a mean follow-up of 24 (3-44) months, mean excess weight loss was 70.7% and 14/20 (70%) co-morbid conditions were improved or resolved. GERD evaluation with the GERD-HRQL scale showed a significant reduction of GERD scores postoperatively (P =0.006). Although LRYGBP after antireflux surgery is a technically more difficult procedure with a higher morbidity, it is feasible and effective for the treatment of recurrent GERD and worsening obesity with the additional advantage of weight loss and improvement of co-morbidities.
    No preview · Article · Nov 2004 · Obesity Surgery
  • [Show abstract] [Hide abstract]
    ABSTRACT: Little objective data are available regarding obesity and the performance of laparoscopic radical prostatectomy (LRP). We reviewed our LRP series to determine the effect of body mass index (BMI) on operative time, blood loss, anastomotic leakage, positive margins, length of stay, complications, urinary continence and erectile function. A single institution retrospective review was performed of 151 sequential LRPs performed by a single surgeon. Patients were separated into those who were nonobese (BMI less than 30), and those with classes I (BMI 30 to 34.9), II (BMI 35 to 39.9) and III (BMI 40 or greater) obesity according to WHO criteria. There were 97 patients in the nonobese and 54 in the obese cohort, including 35, 14 and 5 with classes I to III obesity, respectively. A trend toward greater preoperative prostate specific antigen (p = 0.14), Gleason score (p = 0.06) and American Society of Anesthesiologists classification (p = 0.07) was noted in the obese (BMI 30 or greater) group. The cohorts had similar prostate size (p = 0.11), pathological grade (p = 0.57), pathological stage (p = 0.50), postoperative hemoglobin decrease (p = 0.77) and hospital stay (p = 0.90). The rates of positive margins (p = 1.0), anastomotic leakage (p = 0.49), prostate specific antigen recurrence (p = 1.0) and complication (p = 0.14) were also similar. Early postoperative urinary continence (p = 1.0) and erectile function (p = 0.19) appeared equivalent. Mean operative time +/- SD was greater in obese than in nonobese patients (208 +/- 43 vs 192 +/- 34 minutes, p = 0.02). Mean operative time was longer in patients with classes II and III obesity (220 +/- 47 minutes, p <0.05 and 249 +/- 32, p <0.01, respectively). The class III group had a longer mean operative time than the class I obesity group (198 +/- 34 minutes, p <0.05). Obese patients underwent a greater number of additional procedures at the time of LRP (p = 0.01). While obesity significantly increased LRP operative time, it did not significantly impact other intraoperative and postoperative surgical parameters. LRP should be offered to obese patients as a feasible and effective treatment option for prostate cancer.
    No preview · Article · Feb 2005 · The Journal of Urology
Show more