Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2025
Concurrent surgical management of achalasia and obesity: a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program analysis.
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Ebadinejad Amir, Saeidishahri Sara, Wu Yin, Bond Dale S, Benbrahim Aziz, Hannoush Edward, Tishler Darren, Papasavas Pavlos
Аннотация
BACKGROUND: The safety of concurrent Heller myotomy (HM) and metabolic bariatric surgery (MBS) remains underexplored, with existing literature limited to case reports. This study aimed to evaluate the 30-day postoperative outcomes of concurrent HM-MBS vs MBS alone.
METHODS: A retrospective analysis of the 2020-2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was conducted. HM-MBS cases were identified. To minimize confounding, propensity score matching (1:3) was performed using 25 preoperative characteristics. The 30-day postoperative outcomes and complications, categorized using the Clavien-Dindo classification (CDC), were compared between the HM-MBS and MBS groups using independent samples t tests/rank-sum and chi-square tests/Fisher exact tests. Subgroup analyses were performed for the primary and conversion procedures.
RESULTS: After matching, 336 patients (HM-MBS: n = 84; MBS: n = 252; mean age: 52.3 ± 10.9 years; 85.4% female) were analyzed, including 236 primary and 100 conversion procedures. Compared with the MBS group, the HM-MBS group had significantly prolonged operative times (123.6 ± 59.8 vs 210.9 ± 72.3 minutes, respectively; P <.001) and hospital stays (1.56 ± 1.20 vs 3.60 ± 6.90 days, respectively; P =.007). Overall complications were higher in the HM-MBS group than in the MBS group (27.4% vs 10.7%, respectively; P <.001), including increased gastrointestinal bleeding (3.6% vs 0.0%, respectively; P =.015), surgical site infections (6.0% vs 1.2%, respectively; P =.026), ventilator support (3.6% vs 0.0%, respectively; P =.015), and sepsis (6.0% vs 0.4%, respectively; P =.004). The rates of severe complications (CDC grade ≥ IIIa) were higher in the HM-MBS group than in the MBS group (overall: 16.7% vs 2.8%, respectively; P <.001; reoperation: 8.3% vs 1.6%, respectively; P =.007; reintervention: 8.3% vs 1.2%, respectively; P =.003). Subgroup analyses revealed similar patterns across the primary and conversion procedures.
CONCLUSION: Concurrent HM-MBS is associated with significantly higher postoperative morbidity, suggesting the need for careful consideration of surgical timing in patients who require both procedures.
METHODS: A retrospective analysis of the 2020-2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was conducted. HM-MBS cases were identified. To minimize confounding, propensity score matching (1:3) was performed using 25 preoperative characteristics. The 30-day postoperative outcomes and complications, categorized using the Clavien-Dindo classification (CDC), were compared between the HM-MBS and MBS groups using independent samples t tests/rank-sum and chi-square tests/Fisher exact tests. Subgroup analyses were performed for the primary and conversion procedures.
RESULTS: After matching, 336 patients (HM-MBS: n = 84; MBS: n = 252; mean age: 52.3 ± 10.9 years; 85.4% female) were analyzed, including 236 primary and 100 conversion procedures. Compared with the MBS group, the HM-MBS group had significantly prolonged operative times (123.6 ± 59.8 vs 210.9 ± 72.3 minutes, respectively; P <.001) and hospital stays (1.56 ± 1.20 vs 3.60 ± 6.90 days, respectively; P =.007). Overall complications were higher in the HM-MBS group than in the MBS group (27.4% vs 10.7%, respectively; P <.001), including increased gastrointestinal bleeding (3.6% vs 0.0%, respectively; P =.015), surgical site infections (6.0% vs 1.2%, respectively; P =.026), ventilator support (3.6% vs 0.0%, respectively; P =.015), and sepsis (6.0% vs 0.4%, respectively; P =.004). The rates of severe complications (CDC grade ≥ IIIa) were higher in the HM-MBS group than in the MBS group (overall: 16.7% vs 2.8%, respectively; P <.001; reoperation: 8.3% vs 1.6%, respectively; P =.007; reintervention: 8.3% vs 1.2%, respectively; P =.003). Subgroup analyses revealed similar patterns across the primary and conversion procedures.
CONCLUSION: Concurrent HM-MBS is associated with significantly higher postoperative morbidity, suggesting the need for careful consideration of surgical timing in patients who require both procedures.