The Impact of Body Mass Index on Recurrence Rates Following Laparoscopic Paraesophageal Hernia Repair

Abstract

Introduction: Laparoscopic paraesophageal hernia repair (LPEHR) has a reported recurrence rate of nearly 50%. While the etiology of these recurrences is multifactorial, obesity likely plays a role. The aim of this study is to determine the impact of Body Mass Index (BMI) on hiatal hernia recurrence following LPEHR. Methods: Retrospective review of a prospectively collected foregut surgical database identified patients who underwent a primary standard elective LPEHR between 2006 and 2012 and objective follow up >12 months after surgery. Hernia recurrence was defined as >2 cm axial displacement of fundoplication/stomach above the diaphragm on barium swallow/endoscopy. Data was analyzed based on BMI. Results: Of 236/350 (67%) who had long term-objective follow-up (mean 34 months), the overall recurrence rate was 24%. Recurrence rates were lower for patients with normal BMI (10.8% vs 26.1%, P < .05). Recurrence rates were similar across elevated BMI groups (overweight = 31%, class I = 24%, class II = 24%, class III = 18%, P = NS). The odds of recurrence was 2.92 (95% CI: 0.99-8.64) greater for patients with BMI > 25 than for normal weight individuals. There was no difference in recurrence rates based BMI <or>35. Conclusions: Patients with a normal BMI experience significantly lower recurrence rates following laparoscopic paraesophageal hernia repair. The increased risk appears to be similar across BMI categories, including individuals who do not meet criteria for formal weight loss surgery. Therefore, a BMI greater than 35 alone is not a reliable demarcation of recurrence risk. Efforts to achieve normal weight pre-operatively are recommended to minimize recurrences.