PULMONARY FUNCTION AFTER LAPAROSCOPIC ANTI-REFLUX
SURGERY IN PATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS
Keliang Xiao1, Ellen Morrow2
Ganesh Raghu2, Marcelo Hinojosa2, Brant Oelschlager2, Carlos Pellegrini2
1UMKC
School of Medicine, 2University of Washington School of Medicine
Introduction
Results
• There is currently no effective medical
therapy for Idiopathic Pulmonary
Fibrosis (IPF)
• Increasing evidence associates IPF with
Gastro-esophageal reflux disease
(GERD)1
• We hypothesized that patients with IPF
would have decreased decline in
pulmonary function after laparoscopic
anti-reflux surgery (LARS), as measured
by forced vital capacity (FVC).
-27 patients fit the inclusion criteria
SAFETY:
• There were no operative complications.
• There were two complications within 30 days: both dysphagia requiring readmission.
• There were no mortalities within 90 days of LARS.
• Two reoperations: one patient was converted to a Dor at 3 months postoperative, and one redo
Nissen was performed 12 years later.
EFFICACY:
23 patients had postoperative pH studies; all but two normalized. The mean DeMeester score
dropped from 37 to 5 after LARS (normal=14.7).
The mean FVC increased from 2.69L to 2.79L from preop to postop. These tests were performed
approximately 3 months preop and postop.
Methods
• We performed a retrospective review of
surgical cases in a single institution.
• All patients who had a diagnosis of IPF
(by CT or lung biopsy) and underwent
LARS were included.
• Those who also underwent lung
transplant without intervening PFTs
were excluded.
• The study period was 09/1998 to
12/2012.
• Pulmonary function test, pH, and safety
data were collected.
Estimates
Estimate
Standard
Error
DF
t Value
Pr > |t|
pre_year
-0.1470
0.07162
26
-2.05
0.0504
post_year
0.02943
0.08007
26
0.37
0.7162
post - pre
0.1764
0.1189
26
1.48
0.1500
Table 1: Estimated slope of FVC change preop and postop
Conclusion
• LARS can be performed safely in this high-risk patient
population
• Lung function stabilized after LARS in patients with IPF.
• LARS may be an effective treatment for IPF.
• Data from a planned randomized controlled clinical trial
are needed to confirm these findings.
References
1. Hoppo T, et al. Gastroesophageal reflux disease and
patterns of reflux in patients with idiopathic pulmonary
fibrosis using hypopharygeal multichannel intraluminal
impedence. Dis Esophagus. 2012; 10.1111/j: 1442-46
Figure 1: Observed FVC values preop and postop