Laparoscopic Antireflux Surgery for Gastroesophageal Reflux Disease After Lung Transplantation

• Published in: The Journal of surgical research 2011-10, Vol.170 (2), p.e279-e286
• Main Authors: Fisichella, P. Marco, M.D, Davis, Christopher S., M.D., M.P.H, Gagermeier, James, M.D, Dilling, Daniel, M.D, Alex, Charles G., M.D, Dorfmeister, Jennifer A., M.D, Kovacs, Elizabeth J., Ph.D, Love, Robert B., M.D, Gamelli, Richard L., M.D
• Format: Article
• Language: English
• Subjects: Adult; Barrett Esophagus - mortality; Barrett Esophagus - physiopathology; esophageal function testing; Esophagitis - mortality; Esophagitis - physiopathology; Esophagus - physiopathology; Female; Gastroesophageal Reflux - mortality; Gastroesophageal Reflux - physiopathology; Gastroesophageal Reflux - surgery; gastroesophageal reflux disease (GERD); Hernia, Hiatal - mortality; Hernia, Hiatal - physiopathology; Humans; Hydrogen-Ion Concentration; laparoscopic antireflux surgery; Laparoscopy - mortality; Lung Diseases - mortality; Lung Diseases - surgery; lung transplantation; Lung Transplantation - mortality; Male; Manometry; Middle Aged; Morbidity; Postoperative Complications - mortality; Postoperative Complications - physiopathology; Postoperative Complications - surgery; Prevalence; Retrospective Studies; Risk Factors; Surgery
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2011.05.038

Background Although gastroesophageal reflux disease (GERD) is highly prevalent in lung transplantation, the pathophysiology of GERD in these patients is unknown. We hypothesize that the pathophysiology of GERD after lung transplantation differs from that of a control population, and that the 30-d morbidity and mortality of laparoscopic antireflux surgery (LARS) are equivalent in both populations. Methods We retrospectively compared the pathophysiology of GERD and the 30-d morbidity and mortality of 29 consecutive lung transplant patients with 23 consecutive patients without lung transplantation (control group), all of whom had LARS for GERD between November 2008 and May 2010. Results Both groups had a similar prevalence of endoscopic esophagitis and Barrett’s esophagus , comparable manometric profiles, and similar prevalence of abnormal peristalsis. However, hiatal hernia was more common in controls than in lung transplant patients (57% versus 24%; P = 0.04). Lung transplant patients had a higher prevalence and severity of proximal GERD (65% versus 33%; P = 0.04). The 30-d morbidity and mortality following LARS were similar in both groups regardless of the higher surgical risk of lung transplants (median ASA class: 3 versus 2 for controls, P < 0.001). Conclusions These results show that despite similar manometric profiles, lung transplant patients are more prone to proximal reflux than the general population with GERD; the prevalence of endoscopic esophagitis and Barrett’s esophagus is the same in both groups of patients; a hiatal hernia is uncommon after lung transplantation; and the morbidity and mortality of LARS are the same for lung transplant patients as the general population with GERD.