D'Alessio MJ et al. (2005) Obesity is not a contraindication to laparoscopic Nissen fundoplication. J Gastrointest Surg 9: 949–954

Gastroesophageal reflux disease (GERD) is common in obese patients; however, obesity has long been considered a contraindication to laparoscopic antireflux surgery. To date, conflicting results have been obtained regarding the association between antireflux surgery outcomes and preoperative BMI. D'Alessio and colleagues identified a cohort of GERD patients who underwent laparoscopic Nissen fundoplication, and examined the influence of preoperative BMI on their clinical outcomes.

In total, 257 patients were included in the study, classified according to their preoperative BMI as normal, overweight or obese (BMI <25, 25–30, or >30, respectively). The frequency and severity of GERD symptoms, including dysphagia and heartburn, were graded by patients using the Likert scale, both preoperatively and postoperatively. Patients were advised to lose weight before surgery.

Fundoplication surgery was completed in all patients. The duration of hospitalization did not differ significantly between groups, but a slight (nonsignificant) trend was observed for longer operation times for obese patients. At follow-up (mean 25.5 months), heartburn and dysphagia symptom scores were significantly reduced in all three patient groups; the difference between the groups was not significant. In addition, excellent or good outcome ratings were given by 80% of patients, and similar ratings were recorded by each BMI group.

The authors conclude that laparoscopic Nissen fundoplication surgery is safe and effective in treating overweight and obese GERD patients, and highlight the need for further study into the effect of preoperative weight loss on fundoplication outcome in obese patients.