Preexisting GERD Predicts Reoperation in Bariatric Surgery Patients

Patients with gastroesophageal reflux disease (GERD) are more likely to have a second operation following bariatric surgery compared with patients without the disease.

Among all surgeries (including bariatric surgeries), 24% of insured patients are reoperated on within 2 years, and 6% occur within 30 days of the initial surgery.

Each reoperation following bariatric surgery costs $12,000, so any effort to reduce reoperation is likely to reduce health care costs.

Past studies have suggested that GERD increases the risk of gastrointestinal ulcers and ups the likelihood of reoperation after bariatric surgery.

Now, a team of researchers from Johns Hopkins Department of Surgery have assessed GERD's effect on reoperation rates and contributed to that body of evidence in an article published online in the October 2015 issue of the Journal of Gastrointestinal Surgery.

The authors examined 533 laparoscopic gastric bypass or laparoscopic sleeve gastrectomy surgeries at their department between 2009 and 2013.

The study authors found a 9% reoperation rate over a 5-year period with a median follow-up of 3.7 years and a mean follow-up of 3.6 years.

White patients with GERD were 2.2 times more likely to undergo an additional surgery, and black patients were 1.4 times more likely to have a reoperation than race-matched patients who did not have GERD.

While high body mass indexes (BMIs) have been consistently associated with reoperation rates, patients with GERD had lower BMI values than non-GERD patients, according to the researchers.

Meanwhile, esophageal ulcers, Barrett’s Esophagus, and esophageal adenocarcinoma are more likely in white GERD patients than in black patients, regardless of other risk factors.

The American College of Gastroenterology indicates that GERD is more aggressive in white patients, especially older men, possibly due to lifestyle or genetic factors.

Bariatric surgery patients who have GERD and its associated comorbidities often seek health care for GERD-related symptoms. During those visits, their symptoms may mimic serious post-operative complications (eg, anastomotic leak, bleeding, and enteric fistulas) and lead clinicians to be more aggressive in their assessments.

GERD also increases risk of incisional hernia and/or wound-related complications, and small bowel obstruction.

Further, GERD causes irritating microaspirations, which induce cough and then cause or aggravate incisional hernias.

All of these factors may contribute to the decision to reoperate.