title: Association of Body Mass Index (BMI) with Patterns of Fundoplication Failure: Insights Gained.
abstract: BACKGROUND
  Obesity has been implicated as an important risk factor for fundoplication failure. However, the mechanism of fundoplication in obese patients is not fully understood. Our objective is to evaluate the patterns of failure in relation to the body mass index (BMI) undergoing re-operative intervention after failed fundoplication.
  
  
  METHODS
  After Institutional Review Board approval, the patients who underwent re-operative intervention for failed fundoplication between November 2008 and December 2013 were identified. Patients were classified into three groups: non-obese, obese, and morbidly obese (<30, 30-35, >35 BMI, respectively). Pre-operative assessment and operative procedure performed were compared between the groups.
  
  
  RESULTS
  One hundred twenty-four patients satisfied study criteria. Non-obese patients (53.2 %) had significantly more dysphagia as an indication for re-operative procedure (obese 31.6 %, p < 0.05; morbidly 16.7 %, p < 0.05). Obese and morbidly obese patients had significantly higher incidence of recurrent hiatal hernia than non-obese patients (88.7 vs. 65.6 %, p < 0.05). Morbidly obese patients had significantly higher incidence of disrupted fundoplication than non-obese patients (41.7 vs. 19.4 %, p < 0.05).
  
  
  CONCLUSIONS
  Similar anatomical failure patterns of state of fundoplication and recurrent hiatal hernia were noted between obese patients and morbidly obese patients and were distinct from non-obese patients.
authors.affiliation: Department of Surgery, Creighton University Medical Center, 601 North 30th Street, Suite 3700, Omaha, NE, 68131, USA.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Akimoto
authors.affiliation: Department of Surgery, Creighton University Medical Center, 601 North 30th Street, Suite 3700, Omaha, NE, 68131, USA.
authors.forename: Kalyana C
authors.initials: KC
authors.lastname: Nandipati
authors.affiliation: Department of Surgery, Creighton University Medical Center, 601 North 30th Street, Suite 3700, Omaha, NE, 68131, USA.
authors.forename: Harit
authors.initials: H
authors.lastname: Kapoor
authors.affiliation: Department of Surgery, Creighton University Medical Center, 601 North 30th Street, Suite 3700, Omaha, NE, 68131, USA.
authors.forename: Se Ryung
authors.initials: SR
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, Creighton University Medical Center, 601 North 30th Street, Suite 3700, Omaha, NE, 68131, USA.
authors.forename: Pradeep K
authors.initials: PK
authors.lastname: Pallati
authors.affiliation: Department of Surgery, Creighton University Medical Center, 601 North 30th Street, Suite 3700, Omaha, NE, 68131, USA. skmittal@creighton.edu.
authors.forename: Sumeet K
authors.initials: SK
authors.lastname: Mittal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors; D017211:Treatment Failure; D055815:Young Adult
keywords: Anti-reflux surgery; Failed fundoplication; Obesity; Redo fundoplication; Roux-en-Y