Systematic review and meta-analysis on the effect of obesity on recurrence after laparoscopic anti-reflux surgery

Yasir Bashir*, Hazel Ní Chonchubhair, Sinead N. Duggan, Robert Memba, Qurat ul Ain, Anne Murphy, Jean McMahon, Paul F. Ridgway, Kevin C. Conlon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)

Abstract

Background & aims
Laparoscopic anti-reflux surgery (LARS) aims to provide relief from gastroesophageal reflux disease (GORD). With increase in the prevalence of obesity, there is a concurrent increase in obese patients requiring LARS. In addition to being a more technically difficult procedure, there is conflicting evidence regarding the effectiveness of LARS in obese patients. We performed a systematic review and meta-analysis to compare the outcomes of LARS in obese versus non-obese patients.

Methods
Articles on the effects of obesity on LARS were identified from Ovid Medline, EMBASE and the Cochrane Library databases up to 30th of November 2016. Two independent searches were conducted. Data were extracted independently by two researchers. The primary outcome was recurrence, whilst the secondary outcome was operative time. Pooled data were statistically analysed using forest and funnel plots.

Results
Twelve studies (3346 patients) met the inclusion criteria, with 923 patients in the obese group and 2423 patients in the non-obese group. Based on a random effects model, there was a risk ratio of 1.36 (95% CI 1.08–1.72, p = 0.009), if studies reporting recurrence objectively are analysed risk ratio of 1.53 (95% CI 1.01–2.32, p = 0.05) showing 53% increased risk of recurrence for obese patients. Using a random effects model, the difference in operative time was 13.94 min (95% confidence interval (CI) 9.33–18.55, p < 0.0001), showing an increased operative time for obese patients.

Conclusion
A meta-analysis of 12 studies showed that there was greater recurrence of GORD symptoms and longer operative time relating to LARS in obese patients compared to non-obese patients.

Original languageEnglish
Pages (from-to)107-118
JournalThe Surgeon
Volume17
Issue number2
Early online date08 Mar 2019
DOIs
Publication statusPublished - Apr 2019
Externally publishedYes

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