CLASS I AND II OBESITY IS ASSOCIATED WITH COMPARABLE LONGTERM IMPROVEMENT IN DISEASE-SPECIFIC QUALITY OF LIFE AFTER LAPAROSCOPIC NISSEN FUNDOPLICATION COMPARED TO NON-OBESE PATIENTS
Anahita D. Jalilvand*1, Lindsey Clemmons1, Sara Mardin del Campo2, Anand Gupta1, Kyle A. Perry1
1General Surgery, Ohio State Medical Center, Hilliard, OH; 2Swedish Medical Center, Seattle, WA
INTRODUCTION: The role of laparoscopic Nissen fundoplication (LNF) for medically-refractory gastroesophageal reflux disease (r-GERD) in obese patients is controversial. While we previously reported excellent short-term reflux control without increased perioperative morbidity after LNF in obese and non-obese groups, this study assessed the long-term impact of LNF in this cohort. We hypothesized obese patients undergoing LNF for r-GERD would exhibit similar improvement in disease-specific quality of life (GERD-HRQL) compared to controls without increased reoperation or weight gain over time.
METHODS: We tested this hypothesis in a retrospective cohort who underwent LNF for r-GERD between 2009 and 2014 (n=176). Patients were stratified by BMI into non-obese control (Ctl; n=76; BMI <30 kg/m2), class 1 (Ob-1; n=53; BMI 30-35 kg/m2), and class 2 (Ob-2; n=47; BMI 35-40 kg/m2) obese groups. Baseline demographics, objective testing, GERD-HRQL scores, and follow-up data, collected by telephone interview, at short-term (STFU, 17 [10-32] months) and long-term (LTFU, 72 [64-89] months) intervals were collected in a prospective institutionally approved database. The primary outcome was LTFU GERD-HRQL score, while protein-pump inhibitor (PPI) use, reoperation, procedural satisfaction, and weight change were secondary outcomes. Within and between group comparisons were performed using Chi-square, Fisher’s exact, Kruskal Wallis, Wilcoxon signed-rank, and Mann Whitney tests; a repeated-measures mixed model was used to compare GERD-HRQL scores over time. Data are presented as median (IQR), and p <0.05 was significant.
RESULTS: The groups did not differ in terms of age, gender, DeMeester score, or baseline GERD-HRQL score, but Ob-2 patients (66%) were more likely to have an ASA score of 3 or 4 than Ob-1 (42%) or Ctl (43%, p=0.02) patients. GERD-HRQL scores improved significantly in all groups from baseline to STFU (p<0.01) and LTFU (p<0.01). The GERD-HRQL scores did not differ between groups at STFU (p=0.83) or LTFU (p=0.56, Figure 1A-B). At LTFU, PPI use was significantly more likely in Ob-2 patients (67%) compared to Ob-1 (31%) and Ctl (24%, p<0.01). Rates of reoperation (4% v. 8% v. 9%, p=0.88) did not differ. Weight change at LTFU was -6.1 (-13.1-3.7) kg for Ob-2 patients compared to -1.1 (-9.5-1.2) for Ob-1 patients and 0 (-3.3-4.2, p=0.10) for Ctl patients. Ninety percent of Ob-2 patients expressed procedural satisfaction at LTFU compared to 84% and 80% of Ob-1 and Ctl patients, respectively (p=0.62).
CONCLUSIONS: Compared to controls, obese patients exhibited comparable improvement in disease-specific quality of life and high satisfaction rates 6 years following LNF. Patients with class II obesity reported higher long-term PPI use without increased risk of reoperation. This demonstrates that LNF can provide durable reflux control in select obese patients.
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