Outcomes after laparoscopic anti-reflux surgery related to obesity: A systematic review and meta-analysis

Background: Laparoscopic Anti-Reflux Surgery (LARS) is an established alternative treatment to pharmacological therapy for patients with Gastro Osophageal Reflux Disease (GORD), yet its safety and efficacy in obese patients is controversial. A systematic review and meta-analysis was performed to compare LARS related to obesity. Methods: Embase, MEDLINE and the Cochrane Library (January 1970 to July 2017) were searched for studies reporting clinical outcomes of LARS in patient cohorts stratified by Body Mass Index (BMI). Data was grouped according to BMI, < 30 kg/m(2) (non-obese) and >= 30 kg/m(2) (obese). Primary outcome measures were reflux recurrence, operative morbidity, re-intervention (redo surgery and endoscopic dilatation), conversion to open surgery, and early return to theatre. Results were pooled in meta-analyses as Odds Ratios (OR). Results: Thirteen eligible observational studies comparing LARS in non-obese (n = 6246) and obese (n = 1753) patients were identified. Recurrence of reflux was significantly lower in the non-obese cohort (OR 0.28, 95% C.I. 0.13 to 0.61, p = 0.001), however no significant differences were observed in rates of operative morbidity (OR 0.82, 0.54 to 1.23, p = 0.33), redo surgery (OR 0.94, 0.51 to 1.72, p = 0.84), endoscopic dilatation (OR 0.98, 0.45 to 2.17, p = 0.97), conversion to open surgery (OR 0.96, 0.50 to 1.85, P = 0.90), or early return to theatre (OR 0.77, 0.43 to 1.38, p = 0.39). Conclusions: LARS can be performed safely in obese patients, but risks higher GORD recurrence. Clinicians and patients should be aware that obesity may adversely affect LARS outcome and careful consideration be given in the consent process inherent within the optimal management of GORD.