Laparoscopic anti-reflux surgery is effective in obese patients with gastro-oesophageal reflux disease

INTRODUCTION Obesity has long been regarded as a risk factor for the development of gastro-oesophageal reflux disease (GORD). It has been claimed that surgical efficacy of laproscopic anti-reflux operations is decreased in obese patients. The aim of this study was to assess whether laproscopic anti-reflux surgery is effective in obese patients with GORD compared to non-obese patients. PATIENTS AND METHODS A total of 366 patients (mean age 44 years; range, 12-86 years) underwent laparoscopic anti-reflux surgery between 1997-2003. Of these, 74 patients were considered obese; 58 patients had a body mass index (BMI) of 30-34 kg/m(2) and 16 were classified as morbidly obese with a BMI > 35 kg/m(2). Pre operative symptomatic scoring, indications for surgery, pH studies, operative times and complications were compared between obese and non obese patients. Symptomatic outcome and Visick score between the two groups were assessed at 6 weeks-6 months and 1 year following surgery. RESULTS Failure of medical treatment was the main reason for surgery in all groups. Operative time was longer in obese patients (mean time 93 min compared to 81 min, P = 0.0007), the main difficulty being gaining across because of their body habitus. All group found the procedure to be effective in symptomatic outcome, 91% of obese patients compared to 92% of non-obese patients scored Viscik I or II at 6 weeks' postoperatively. Similar Viscik scoring was shown between the two groups at 6 months and 1 year, and in the morbidily obese group. CONCLUSIONS The outcome of laproscopic anti-reflux surgery is similar between obese and non-obese patients with ni trend towards a worse outcome in the obese or morbidly obese. Obesity should not be seen as a contra-indication, although it may be more technically challenging in this group of patients. Good results can be achieved in obese patients.