S3379 Comparing Common Anti-Reflux Surgeries to Their Outcomes and Complications

Abstract

Introduction: Gastroesophageal reflux disease (GERD) is caused by frequent relaxation of lower esophageal sphincter for multiple reasons. Laparoscopic anti-reflux surgery is an alternative treatment for patients with refractory gastro-esophageal reflux disease. Our aim is to describe the outcomes of the four more common types of anti-reflux surgeries and their associated complications in patients with a long-standing history of GERD. Methods: A retrospective review of 278 patients undergoing four different anti-reflux surgeries at a tertiary care center for esophageal reflux excellence was performed between 2015 and 2020. Primary outcomes included identifying all-cause readmission rates at 30 and 90-days, length of stay, whether they were put on anti-reflux medications postoperatively and whether they needed a secondary surgery for revisions. Secondary outcomes included analyzing postoperative complications such as bleeding requiring transfusions, infections such as urinary tract infections (UTI), pneumonias or central line associated blood stream infections (CLABSI) as well as post-operative cardiac arrythmias. Analysis included age, gender, body mass index, surgery duration, and perioperative data. STATA 14.2 was used for appropriate statistical analysis. Descriptive analysis as well as a simple and multiple regression analysis were used. Results: The laparoscopic repair of paraoesophageal hernia was the most commonly performed procedure 137/278 (49.3%), followed by laparoscopic repair of hiatal hernia in 98/278 (35.3%), the Nissen Fundoplication procedure in 31/278 (11.2%) and Redo Nissen fundoplication in 12/278 (4.3%). The average length of stay was 4.8 days (95% CI 4.5-5.2). Women were the majority of patients 207/278 (75%) and the average age was 65-year-old (95% confidence interval: 64-67). Obesity defined as BMI >30 was present in 42.9% of patients with a (95% confidence interval: 0.37-0.48). Only 12% of the patients required surgical revision (95% confidence interval: 0.09-0.17). Complications including need for surgical revision, readmission, infection, bleeding or arrythmia occurred in 73 patients (26%) of the patients. Conclusion: There was a low risk for peri-operative complications, readmission and need for repeat surgery. Different procedures were effective in treating GERD with laparoscopic repair of hiatal hernia having significantly more need for post-operative medications to treat GERD. The data includes significantly more women which could limit the generalizability to men.