A Relação entre o índice de massa corporal e desfechos pós-operatórios em pacientes submetidos ao tratamento operatório de doença do refluxo gastroesofágico: uma revisão integrativa / Relationship between body mass index and postoperative outcomes in patients undergoing operative treatment for gastroesophageal reflux disease: an integrative review

Abstract

INTRODUCTION: Gastroesophageal Reflux Disease (GERD) affects approximately 12% of the Brazilian population and is characterized by the abnormal presence of gastric contents above the lower esophageal sphincter. Characteristic symptoms include: heartburn, dysphagia, and regurgitation. The diagnosis is made by clinical evaluation and upper digestive endoscopy. The treatment for GERD is predominantly clinical, using proton pump inhibitors and behavioral measures. When the disease is refractory, operative treatment is an option. However, there is controversy in the literature regarding the results of surgical treatment in obese patients compared to patients with normal body mass index (BMI). Obesity is a risk factor for GERD, and it may be associated with other postoperative risk factors.

OBJECTIVES: This integrative literature review was carried out with the aim of evaluating the repercussions of high BMI in patients undergoing anti-reflux surgery, as well as its implication as a predisposing factor for postoperative complications.

METHODOLOGY: This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) items. The development method consisted of searching for articles in the research platforms PubMed, BVS, Cochrane Reviews and SciELO. For the selection of articles, the Rayyan Platform was used. The articles resulting from the search strategies were added, and five collaborators were invited to blindly select them. Another 3 articles were selected after analyzing the references of previously selected articles. Finally, 11 articles were included in the final review.

RESULTS/DISCUSSION: Although obesity may influence the development of GERD and the complexity of the proposed operation, studies have compared postoperative outcomes in patients with BMI < 25 kg/m² (normal), BMI = 25-29.9 (overweight ) kg/m² and BMI > 30 kg/m² (obese), concluding that this is not a predictor of negative outcomes in patients undergoing surgical treatment. Studies evaluated suggested that fundoplication can be used to treat refractory GERD, but it can lead to a series of complications, even in patients with normal BMI. It has been reported that about 20% of patients undergoing anti-reflux surgery continue to experience symptoms, and laparoscopic Nissen fundoplication (LARS) fails to control gastroesophageal reflux in nearly 15% of patients. Reoperation, when fundoplication fails, is a difficult challenge, with limited evidence. Currently, it is more common to find cases of patients who need to undergo a reoperation due to the failure of the previous surgery and the reappearance of symptoms such as dysphagia, abdominal distension, inability to vomit and excessive release of gases, than to perform a fundoplication operation to the treatment of GERD.

CONCLUSION: The most commonly used treatment for GERD consists of pharmacological therapy associated with behavioral measures. Despite obesity being an important risk factor for the disease, no relationship was found between obesity and negative postoperative outcomes in patients undergoing fundoplication. Furthermore, the rate of complications and operation failures is similar in patients with normal BMI.