Obesity is not associated with increased adverse outcomes following paraesophageal hernia repair

Obesity is associated with increased intra-abdominal pressure and higher prevalence of paraesophageal hernias (PEHs), yet its impact on outcomes following PEH repair remains unclear. This study evaluated postoperative outcomes following isolated PEH repair in obese and non-obese patients and examined whether increasing obesity severity influences risk of adverse outcomes.

A retrospective cohort study was conducted of patients undergoing elective isolated PEH repair at an academic health-system (2010-2023). Patients were stratified as obese (BMI ≥ 30) or non-obese (BMI < 30). The primary outcome was a composite adverse outcome (CAO) defined as postoperative GERD or dysphagia > 30 days, hernia recurrence, or reoperation. Multivariable logistic regression was used to identify factors associated with CAO. A sub-analysis stratified patients into non-obese, class I-II obesity (BMI 30- < 40), and class III obesity (BMI ≥ 40).

A total of 530 patients met inclusion criteria, including 254 obese (47.9%) and 276 non-obese (52.1%) patients. Obese patients were younger (median 63 vs. 66, p = 0.003) and more frequently had obstructive sleep apnea (13.0% vs. 6.9%, p = 0.018). Operative characteristics were similar between groups. CAO occurred in 52.0% of obese patients and 54.0% of non-obese patients (p = 0.64). Rates of GERD, dysphagia, recurrence, reoperation, and 30-day complications were also comparable. On multivariable analysis, obesity was not associated with CAO (OR 0.90, 95% CI 0.63-1.29), while cardiovascular disease increased odds of CAO (OR 1.60, 95% CI 1.04-2.44). Outcomes remained similar across BMI strata in the obesity-severity sub-analysis, but only 15 of the 254 obese patients had class III obesity.

Obesity was not associated with worse postoperative outcomes following isolated PEH repair. These findings support the safety of PEH repair in obese patients. However, the small number of patients with class III obesity limits definitive conclusions, and further study is needed to better define outcomes in this population.