title: Is laparoscopic antireflux surgery safe and effective in obese patients?
abstract: BACKGROUND
  It is not clear whether obesity has any negative impact on the results of laparoscopic antireflux surgery (LARS). In this prospective study we investigated the effect of body mass index (BMI) on the surgical outcome of LARS.
  
  
  METHODS
  Patients undergoing primary LARS were divided into three groups: BMI < 25 (normal), BMI = 25-29.9 (overweight), BMI > 30 (obese). All perioperative data, operative and postoperative complications, and follow-up data were recorded prospectively. All patients were seen 2 months postoperatively and yearly thereafter.
  
  
  RESULTS
  One thousand patients underwent LARS from May 2004 to August 2009. There were 484, 384, and 132 patients in normal, overweight, and obese groups, respectively. The incidence of Barrett's metaplasia (8.5% for the entire series) increased with BMI, although this difference was not statistically significant. 684 patients had Nissen and 316 had Toupet fundoplication. Mean follow-up was 53.33 ± 17.21 months. There was no mortality or conversion to open surgery. Mean operating times were 48.04 ± 21.20, 53.54 ± 23.42, and 61.33 ± 28.47 min for normal, overweight, and obese groups, respectively (P = 0.0001). Esophageal perforation, jejunal perforation, and pulmonary emboli were the three major complications in separate patients. Dysphagia occurred in 18.4, 13.1, and 9.9% of normal, overweight, and obese patients, respectively (P = 0.122). Bloating occurred in 18, 14.1, and 20.5 % of normal, overweight, and obese patients, respectively (P = 0.150). Rehospitalization for any reason, excluding redo surgery or dilatation, occurred less in overweight subjects (4.8, 1, and 3.8% respectively, P = 0.008). All other minor complications were distributed evenly among the groups with the exception of hiccups, which occurred more frequently in normal weight patients. Recurrence of reflux was observed in 0.6, 3.6, and 2.3% of the normal, overweight, and obese patients, respectively (P = 0.007).
  
  
  CONCLUSIONS
  LARS is a safe but more demanding procedure in obese patients and a significant increase in complications should not be anticipated. Long-term control of reflux by LARS in higher-BMI patients is slightly worse than that in normal-weight subjects.
authors.affiliation: Department of General Surgery, Pamukkale University Hospital, Kinikli-Denizli, 20060, Turkey. koraytekin@hotmail.com
authors.forename: Koray
authors.initials: K
authors.lastname: Tekin
authors.forename: Toygar
authors.initials: T
authors.lastname: Toydemir
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Yerdel
mesh_terms: D000328:Adult; D001471:Barrett Esophagus / Q000150:complications; D015992:Body Mass Index; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery*; D006551:Hernia, Hiatal / Q000150:complications; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome