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Antireflux surgery for patients with end-stage lung disease before and after lung transplantation

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Abstract

Background

Gastroesophageal reflux disease (GERD) is prevalent among patients with end-stage lung disease (ESLD). This disease can lead to microaspiration and may be a risk factor for lung damage before and after transplantation. A fundoplication is the best way to stop reflux, but little is known about the safety of elective antireflux surgery for patients with ESLD. This study aimed to report the safety of laparoscopic fundoplication for patients with ESLD and GERD before or after lung transplantation.

Methods

Between January 1997 and January 2007, 305 patients were listed for lung transplantation, and 189 patients underwent the procedure. In 2003, routine esophageal studies were added to the pretransplantation evaluation. After the authors’ initial experience, gastric emptying studies were added as well.

Results

A total of 35 patients with GERD or delayed gastric emptying were referred for surgical intervention. A laparoscopic fundoplication was performed for 32 patients (27 total and 5 partial). For three patients, a pyloroplasty also was performed. Two patients had a pyloroplasty without fundoplication. Of the 35 operations, 15 were performed before and 20 after transplantation. Gastric emptying of solids or liquids was delayed in 12 (92%) of 13 posttransplantation studies and 3 (60%) of 5 pretransplantation studies. All operations were completed laparoscopically, and 33 patients recovered uneventfully (94%). The median hospital length of stay was 2 days (range, 1–34 days) for the patients admitted to undergo elective operations. Hospitalization was not prolonged for the three patients who had fundoplications immediately after transplantation.

Conclusions

The results of this study show that laparoscopic antireflux surgery can be performed safely by an experienced multidisciplinary team for selected patients with ESLD before or after lung transplantation, and that gastric emptying is frequently abnormal and should be objectively measured in ESLD patients.

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Acknowledgments

W. Gasper was supported by a grant from the National Institutes of Health (5T32 DK07573–18).

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Authors and Affiliations

  1. Department of Surgery, University of California San Francisco, 521 Parnassus Avenue, Room C-341, San Francisco, CA, 94143, USA

    W. J. Gasper, M. P. Sweet, C. Hoopes & M. G. Patti

  2. Department of Medicine, University of California San Francisco, 400 Parnassus Avenue, Room ACC540, Box 0359, San Francisco, CA, 94143, USA

    L. E. Leard, M. E. Kleinhenz, S. R. Hays & J. A. Golden

Authors
  1. W. J. Gasper
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  2. M. P. Sweet
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  3. C. Hoopes
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  4. L. E. Leard
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  5. M. E. Kleinhenz
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  6. S. R. Hays
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  7. J. A. Golden
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  8. M. G. Patti
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Corresponding author

Correspondence to M. G. Patti.

Additional information

Presented as a Poster of Distinction at the Spring 2007 Meeting of the Society of Gastrointestinal and Endoscopic Surgeons (SAGES) at Las Vegas, Nevada, 18–22 April 2007

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Gasper, W.J., Sweet, M.P., Hoopes, C. et al. Antireflux surgery for patients with end-stage lung disease before and after lung transplantation. Surg Endosc 22, 495–500 (2008). https://doi.org/10.1007/s00464-007-9494-3

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  • DOI: https://doi.org/10.1007/s00464-007-9494-3

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