Systematic review and meta-analysis on the effect of obesity on recurrence after laparoscopic anti-reflux surgery

Bashir, Yasir; Chonchubhair, Hazel Ní; Duggan, Sinead N.; Memba, Robert; Ain, Qurat Ul; Murphy, Anne; McMahon, Jean; Ridgway, Paul F.; Conlon, Kevin C.

doi:10.1016/j.surge.2018.05.001

Cited by 17 publications

(11 citation statements)

References 60 publications

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“…Our results demonstrate, at least short term, that there is no influence of BMI on postoperative complications, when a BMI cutoff point of 32 is used. Overall, we can suggest that shortterm results are similar; however, long-term BMI may adversely affect anti-reflux surgery outcomes, according to recent metaanalyses available 1,2 . About 70% of our patients had complex hiatal hernias, meaning giant paraesophageal or recurrent hernias.…”

Section: Discussionmentioning

confidence: 81%

“…Walter de Biase SILVA-NETO 1 , Claudemiro QUIRESE 1 , Eduardo Guimarães Horneaux de MOURA 2 , Fabricio Ferreira COELHO 3 , Paulo HERMAN 3 ABSTRACT -Background: The treatment of choice for patients with schistosomiasis with previous episode of varices is bleeding esophagogastric devascularization and splenectomy (EGDS) in association with postoperative endoscopic therapy. However, studies have shown varices recurrence especially after long-term follow-up.…”

Section: A Queda Da Pressão Portal Após Desvascularização Esofagogást...mentioning

confidence: 99%

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Impact of Body Mass Index on Perioperative Outcomes for Complex Hiatus Hernia by Videolaparoscopy

Luna

Peixoto

Carvalho³

et al. 2022

ABCD, arq. bras. cir. dig.

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BACKGROUND: The influence of body mass index on perioperative complications of hiatal hernia surgery is controversial in the surgical literature. AIMS: The aim of this study was to evaluate the influence of body mass index on perioperative complications and associated risk factors for its occurrence. METHODS: Two groups were compared on the basis of body mass index: group A with body mass index <32 kg/m2 and group B with body mass index ³32 kg/m2. A multivariate analysis was carried out to identify independent predictors for complications. Complications were classified based on the Clavien-Dindo score. RESULTS: A total of 49 patients were included in this study, with 30 in group A and 19 in group B. The groups were compared based on factors, such as age, Charlson Comorbidity Index, surgical techniques used, type and location of hiatal hernia, and length of stay. Findings showed that 70% of patients had complex hiatal hernia. In addition, 14 complications also occurred: 7 pleuropulmonary and 7 requiring reoperation. From the seven reoperated, there were three recurrences, two gastrointestinal fistulas, one diaphragmatic hernia, and one incisional hernia. Complications were similar in both the groups, with type IV hiatal hernia being the only independent predictor. CONCLUSIONS: Body mass index does not affect perioperative complications in anti-reflux surgery and type IV hiatal hernia is an independent predictor of its occurrence.

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Section: Discussionmentioning

confidence: 81%

Section: A Queda Da Pressão Portal Após Desvascularização Esofagogást...mentioning

confidence: 99%

Impact of Body Mass Index on Perioperative Outcomes for Complex Hiatus Hernia by Videolaparoscopy

Luna

Peixoto

Carvalho³

et al. 2022

ABCD, arq. bras. cir. dig.

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“…We tend to avoid fundoplication in patients with morbid obesity, because hernia recurrence appears to be greater in this population. 18 In addition, a herniated Nissen fundoplication generally causes severe dysphagia and pain and often requires reoperation.…”

Section: The Role Of Fundoplication In Repair Of a Gpehmentioning

confidence: 99%

Giant paraesophageal hernia: What do we really know?

Bhargava

Andrade

2020

JTCVS Techniques

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Feature Editor Note-The management of giant paraesophageal hernias remains challenging. In this invited expert opinion article, Bhargava and Andrade provide an in-depth discussion of the controversies surrounding repair of giant paraesophageal hernias, including management of recurrent hiatal hernias, esophageal-lengthening procedures, and the use of mesh. Based on their own practice, they suggest performing an extensive mediastinal dissection to achieve adequate intra-abdominal esophageal length, gastroplasty when needed for esophageal shortening, and the avoidance of mesh due to the risk of erosion, cost, and lack of clear data supporting its use. Other practices are more controversial, such as placement of a gastrostomy tube for recurrent hernias in the hopes of preventing recurrence, avoidance of a fundoplication in patients with morbid obesity, and usage of a pharyngostomy tube for decompression, which is considered a legacy procedure by most surgeons.Recurrent paraesophageal hernias in particular require a thoughtful approach, including obtaining the operative report from the initial operation when possible, considering the severity of the patient's symptoms, and careful review of objective data from current studies. Patients with multiple previous repairs are unlikely to benefit from a repeat repair, and partial gastrectomy with Roux-en-Y esophagojejunostomy or esophagectomy should be reserved for those with severe symptoms such as the inability to tolerate an oral diet.The authors emphasize the importance of clearly defining what constitutes a giant paraesophageal hernia, the natural history, and an objective assessment of short-and long-term outcomes. While there have been substantial advances, repair of a giant paraesophageal hernia continues to be a challenging procedure, particularly redo repair, and should be performed in experienced, high-volume centers.Giant paraesophageal hernia characterization remains a challenging concept. CENTRAL MESSAGELaparoscopic giant paraesophageal hernia repair remains in evolution. We use extensive mediastinal dissection to achieve intra-abdominal esophageal length, gastroplasty as needed, and avoid mesh.See Commentary on page 373.

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“…112 In addition to its association with reflux disease, obesity is also a strong risk factor for the failure of laparoscopic antireflux surgery with one metaanalysis finding a 53% increased risk over nonobese patients. 113 This has driven the use of Roux-en-Y gastric bypass (RYGB) for patients with a BMI > 35 and GERD with favorable outcomes over fundoplication demonstrated in the literature. [114][115][116] RYGB has a different antireflux mechanism to fundoplication.…”

Section: Rygbmentioning

confidence: 99%

Rethinking gastroesophageal reflux disorder

Banting

Badgery

Read

et al. 2020

Annals of the New York Academy of Sciences

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Gastroesophageal reflux disease (GERD) is a common clinical condition for which our understanding has evolved over the past decades. It is now considered a cluster of phenotypes with numerous anatomical and physiological abnormalities contributing to its pathophysiology. As such, it is important to first understand the underlying mechanism of the disease process for each patient before embarking on therapeutic interventions. The aim of our paper is to highlight the mechanisms contributing to GERD and review investigations and interpretation of these results. Finally, the paper reviews the available treatment modalities for this condition, ranging from medical intervention, endoscopic options through to surgery and its various techniques.

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Systematic review and meta-analysis on the effect of obesity on recurrence after laparoscopic anti-reflux surgery

Abstract: A meta-analysis of 12 studies showed that there was greater recurrence of GORD symptoms and longer operative time relating to LARS in obese patients compared to non-obese patients.

Cited by 17 publications

References 60 publications

Impact of Body Mass Index on Perioperative Outcomes for Complex Hiatus Hernia by Videolaparoscopy

Impact of Body Mass Index on Perioperative Outcomes for Complex Hiatus Hernia by Videolaparoscopy

Giant paraesophageal hernia: What do we really know?

Rethinking gastroesophageal reflux disorder

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