title: Laparoscopic anti-reflux surgery for idiopathic pulmonary fibrosis at a single centre.
abstract: We sought to assess whether laparoscopic anti-reflux surgery (LARS) is associated with decreased rates of disease progression in patients with idiopathic pulmonary fibrosis (IPF).The study was a retrospective single-centre study of IPF patients with worsening symptoms and pulmonary function despite antacid treatment for abnormal acid gastro-oesophageal reflux. The period of exposure to LARS was September 1998 to December 2012. The primary end-point was a longitudinal change in forced vital capacity (FVC) % predicted in the pre- versus post-surgery periods.27 patients with progressive IPF underwent LARS. At time of surgery, the mean age was 65 years and mean FVC was 71.7% pred. Using a regression model, the estimated benefit of surgery in FVC % pred over 1 year was 5.7% (95% CI -0.9-12.2%, p=0.088) with estimated benefit in FVC of 0.22 L (95% CI -0.06-0.49 L, p=0.12). Mean DeMeester scores decreased from 42 to 4 (p<0.01). There were no deaths in the 90 days following surgery and 81.5% of participants were alive 2 years after surgery.Patients with IPF tolerated the LARS well. There were no statistically significant differences in rates of FVC decline pre- and post-LARS over 1 year; a possible trend toward stabilisation in observed FVC warrants prospective studies. The ongoing prospective randomised controlled trial will hopefully provide further insights regarding the safety and potential efficacy of LARS in IPF.
authors: Dept of Medicine, Center for Interstitial Lung Diseases, University of Washington Medical Center, Seattle, WA, USA graghu@uw.edu.
authors: Ganesh
authors: G
authors: Raghu
authors: Dept of Surgery, University of Washington Medical Center, Seattle, WA, USA.
authors: Ellen
authors: E
authors: Morrow
authors: Dept of Medicine, Center for Interstitial Lung Diseases, University of Washington Medical Center, Seattle, WA, USA.
authors: Bridget F
authors: BF
authors: Collins
authors: Dept of Medicine, Center for Interstitial Lung Diseases, University of Washington Medical Center, Seattle, WA, USA.
authors: Lawrence A T
authors: LA
authors: Ho
authors: Dept of Surgery, University of Washington Medical Center, Seattle, WA, USA.
authors: Marcelo W
authors: MW
authors: Hinojosa
authors: Dept of Medicine, Center for Interstitial Lung Diseases, University of Washington Medical Center, Seattle, WA, USA.
authors: Jennifer M
authors: JM
authors: Hayes
authors: Dept of Medicine, Center for Interstitial Lung Diseases, University of Washington Medical Center, Seattle, WA, USA.
authors: Carolyn A
authors: CA
authors: Spada
authors: Dept of Surgery, University of Washington Medical Center, Seattle, WA, USA.
authors: Brant
authors: B
authors: Oelschlager
authors: Dept of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors: Chenxiang
authors: C
authors: Li
authors: Dept of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors: Eric
authors: E
authors: Yow
authors: Dept of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors: Kevin J
authors: KJ
authors: Anstrom
authors: Dept of Surgery, University of Washington Medical Center, Seattle, WA, USA.
authors: Dylan
authors: D
authors: Mart
authors: Dept of Surgery, University of Washington Medical Center, Seattle, WA, USA.
authors: Keliang
authors: K
authors: Xiao
authors: Dept of Surgery, University of Washington Medical Center, Seattle, WA, USA.
authors: Carlos A
authors: CA
authors: Pellegrini
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D054990:Idiopathic Pulmonary Fibrosis / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D012044:Regression Analysis; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012907:Smoking; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014797:Vital Capacity