Pregnancy and delivery after antireflux surgery

Concerns have been raised that subsequent pregnancy after antireflux surgery (ARS) may predispose to wrap disruption or herniation and adversely affect outcomes. Some surgeons withhold ARS in women of childbearing age for fear of this, but outcomes in this population have not been reported.

All childbearing-age women who underwent ARS for gastroesophageal reflux disease (GERD) between January 1991 and July 2000 were asked to complete a detailed questionnaire. Patients with subsequent pregnancies (SP) after ARS were compared with patients without subsequent pregnancies (NP).

Ninety-five of the 118 patients (81%) completed the questionnaire at a mean follow-up of 4.9 years. Fifteen patients had 19 subsequent pregnancies after undergoing ARS, and retching and/or vomiting were reported during 13 of the pregnancies (69%). Preoperative incidence of complicated-GERD including strictures (11% vs. 20%), Barrett's esophagus (19% vs. 13%), esophagitis (36% vs. 33%), and ulceration (4% vs. 0%)-were similar between the nonpregnant and pregnant groups. Incidence of postoperative moderate to severe esophageal (7% vs. 8%) and extraesophageal symptoms (0% vs. 6%) were similar between the SP and NP groups. Postoperative prevalence of antisecretory medications was similar in SP and NP groups (13% and 23%, respectively). The incidence of fundoplications redone did not reach statistical difference between the NP (11%) and SP (0%) groups. Long-term outcomes and failure rates were similar in both groups, except the SP group reported greater overall satisfaction with ARS.

Women of childbearing age have a high incidence of complicated GERD, which may contribute to higher-than-expected rates of symptomatic and anatomic fundoplication failures than first-time ARS. Subsequent pregnancies do not adversely affect outcomes after ARS.