Relationship Between Kyphosis and Postoperative Gastroesophageal Reflux After Proximal Gastrectomy

The prevalence of kyphosis is increasing with increasing life expectancy. One of the most notable gastrointestinal complications is gastroesophageal reflux disease (GERD) in patients with kyphosis. In this study, we investigated the association between kyphosis and the incidence of postoperative GERD in patients who underwent proximal gastrectomy (PG), a procedure with a particularly high risk of GERD.

In total, 54 consecutive patients who underwent PG between 2009 and 2023 met the inclusion criteria. The thoracic/lumbar angle ratio (T/L ratio) derived from sagittal computed tomography was performed to preoperatively assess kyphosis, defined as a T/L ratio ≥ 1.25.

Fifteen patients (27.8%) had kyphosis. Overall, postoperative GERD occurred in seven patients (13.0%). Preoperative albumin levels were significantly lower in the Kyphosis group than in the Normal group (p = 0.03), whereas other clinical characteristics showed no significant differences between the two groups. The incidence of postoperative GERD was significantly higher in the Kyphosis group than in the Normal group (33.3% vs. 5.1%, p = 0.01). Postoperative reflux symptoms also were more frequently observed in the Kyphosis group than in the Normal group (60.0% vs. 16.0%, p = 0.13). Kyphosis was one of the independent predictive factors for postoperative GERD (Odds ratio, 18.7; 95% confidence interval, 1.46-240; p = 0.02) in the multivariate analysis.

Kyphosis was significantly associated with the occurrence of postoperative GERD in patients who underwent PG. Alternative preventive measures may be considered when patients with kyphosis undergo PG.