# Preoperative sarcopenia and its impact on postoperative complications in laparoscopic anti-reflux surgery: a clinical analysis

## TL;DR

This study shows that preoperative sarcopenia delays gastrointestinal recovery and lowers albumin levels after anti-reflux surgery, suggesting the need for prehabilitation.

## Contribution

The study identifies sarcopenia as a modifiable preoperative risk factor impacting recovery in anti-reflux surgery patients.

## Key findings

- Sarcopenia is associated with delayed gastrointestinal function recovery after surgery.
- Sarcopenia leads to lower postoperative serum albumin levels.
- Sarcopenia and age are independent risk factors for delayed recovery.

## Abstract

To investigate the influence of sarcopenia on postoperative outcomes in gastroesophageal reflux disease patients undergoing concomitant laparoscopic hiatal hernia repair and laparoscopic fundoplication.

Retrospective analysis was conducted on 69 patients who underwent laparoscopic hiatal hernia repair combined with laparoscopic fundoplication in the Department of Gastroenterology at the First Hospital of Hebei Medical University from September 2024 to May 2025. Skeletal muscle area at the L3 level was measured using abdominal CT scans within 10 days preoperatively to diagnose sarcopenia. Patients were divided into sarcopenia and non-sarcopenia groups. General clinical data, laboratory findings and postoperative complications were compared between the two groups to investigate the relationship between sarcopenia and postoperative complications following laparoscopic hiatal hernia repair combined with laparoscopic fundoplication.

Patients in the sarcopenia group were significantly older and exhibited lower BMI, lower preoperative scores on the gastroesophageal reflux disease questionnaire, and reduced acid exposure time percentages (all P < 0.05). Furthermore, this group demonstrated significantly lower postoperative serum albumin levels and prolonged gastrointestinal function recovery time (P < 0.05). Multivariate linear regression analysis revealed that, after adjustment for potential confounders including gender, age, and neutrophil percentage, factors such as gender, age, presence of comorbid pulmonary disease, BMI, and preoperative albumin level were independently associated with postoperative albumin levels (all P < 0.05). Additionally, multivariate logistic regression identified preoperative sarcopenia and advanced age as independent risk factors for delayed recovery of gastrointestinal function following laparoscopic hiatal hernia repair combined with fundoplication (P < 0.05).

​Our findings clearly indicate that while preoperative sarcopenia does not elevate the risk of postoperative dysphagia, it significantly delays the recovery of gastrointestinal function and leads to lower albumin levels following surgery in gastroesophageal reflux disease patients. This underscores the critical clinical importance of recognizing sarcopenia as a modifiable preoperative risk factor. We therefore propose the integration of routine sarcopenia screening into the preoperative assessment for gastroesophageal reflux disease patients. For those diagnosed with sarcopenia, a targeted prehabilitation protocol emphasizing nutritional support and physical training could be implemented to potentially enhance surgical tolerance and recovery outcomes. Future studies are warranted to validate the efficacy of such prehabilitation strategies and to further investigate the precise molecular mechanisms through which sarcopenia impedes postoperative recovery.