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IS LAPAROSCOPIC ANTIREFLUX SURGERY SAFE AND EFFECTIVE IN THE OBESE POPULATION? A SYTEMATIC REVIEW AND META-ANALYSIS OF CLINICAL OUTCOMES
Tarig Abdelrahman*1, Ahmed Latif1, David Chan3, Owain R. Griffiths1, Maged F. Farag2, Chris Brown4, Simon Wood4, James Ansell1, Arfon G. Powell5, Wyn G. Lewis4, Tim Havard1, Xavier Escofet2
1General Surgery, Royal Glamorgan Hospital, Cwm Taff, Llantrisant, United Kingdom; 2General Surgery, Prince Charles Hospital, Cwm Taff, Merthyr, United Kingdom; 3General Surgery, Princess of Wales Hospital, ABMU, Bridgend, United Kingdom; 4General Surgery, University Hospital of Wales, Cardiff, United Kingdom; 5Cardiff University, Cardiff, United Kingdom
Background: The prevalence of both Gastroesophageal Reflux Disease (GERD) and obesity in developed countries is increasing. Laparoscopic Anti-Reflux Surgery (LARS) is an established therapy in the treatment of GERD but its safety and efficacy profile in obese patients remains controversial due to perceived technical difficulties and variability in clinical outcomes. A systematic review and meta-analysis was performed to determine and compare the clinical outcomes of LARS in obese and non-obese patients.
Methods: Studies reporting clinical outcomes of LARS in patient groups stratified by BMI were identified from Embase, MEDLINE and the Cochrane Library (January 1970 to November 2016). Data was categorized for non-obese (BMI < 30) and obese (BMI ≥ 30) patients. Outcome measures including perioperative complications, rates of laparoscopic to open conversion, early return to theatre, re-intervention by redo hiatal surgery/endoscopic dilatation and symptom recurrence were analysed. Results were pooled in meta-analyses and described as Odds Ratios (OR).
Results: Eleven eligible observational studies involving 7623 patients were identified comparing LARS for non-obese (n= 6003) and obese (n=1620) patients.
There was no significant difference between non-obese and obese patient groups in rates of perioperative complications (OR 0.87, 95% CI 0.65 to 1.18, p=0.38), conversion to open surgery (OR 1.17, 0.55 to 2.48, p=0.68), early return to theatre (OR 0.77, 0.44 to 1.37, p=0.38), need for redo hiatal surgery (OR 1.08, 0.68 to 1.72, p=0.73) or endoscopic dilatation (OR 1.06, 0.49 to 2.33, p=0.88).
However recurrence of reflux symptoms following LARS was significantly lower in the non-obese group (OR 0.67, 0.48 to 0.99, p=0.02).
Conclusion: This study provides evidence that although LARS can be performed safely in the obese population there appears to be an increased risk of such patients developing recurrent GERD symptoms. Surgeons and patients should be aware that obesity may adversely impact the effectiveness of LARS and ought to be considered when deciding on the optimal management of GERD.
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