Background
Limited evidence exists regarding the outcomes of patients undergoing laparoscopic
adjustable band placement (LAGB) with hiatal hernia (HH) and concomitant hiatal hernia
repair (HHR). The present study evaluated the safety, efficacy, and cost-effectiveness
of primary LAGB (pLAGB) and revisional LAGB (rLAGB) in patients with HH.
Methods
The University HealthSystem Consortium is an alliance of >100 academic medical centers
and nearly 200 affiliate hospitals. The University Health System Consortium database
was queried for patients undergoing LAGB with and without HH from 2006 through 2009.
Results
The patients undergoing rLAGB had a significantly greater prevalence of HH than patients
undergoing pLAGB (18.9% for pLAGB with HH versus 26.3% for rLAGB with HH; P <.001). The mortality (.04% for pLAGB without HH versus 0% for pLAGB with HHR; P >.05), morbidity (3.39% pLAGB without HH versus 2.63% for pLAGB HHR; P >.05), and length of stay (1.33 ± 2.25 days for pLAGB without HH versus 1.17 ± 0.56
days for pLAGB with HHR; P >.05) were comparable in the patients undergoing pLAGB with or without HHR. A trend
was seen toward increased morbidity in patients undergoing rLAGB HHR than in those
undergoing pLAGB HHR (2.63% for pLAGB HHR versus 13.33% for rLAGB HHR; P = .08). The length of stay (1.17 ± 0.56 days for pLAGB HHR versus 1.73 ± 1.49 days
for rLAGB HHR; P <.01) and hospital costs ($12,178 ± 4451 for pLAGB HHR versus $14,616 ± 3538 for
rLAGB HHR; P = .04) were increased for the rLAGB HHR group compared with the pLAGB HHR group.
Conclusion
The results of the present study have demonstrated the safety of HHR concomitant with
pLAGB. In addition, rLAGB was associated with increased morbidity and cost. These
data suggest the safety, efficacy, and cost-effectiveness of crural repair of HH simultaneously
with pLAGB.
Keywords
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Article info
Publication history
Published online: August 27, 2010
Accepted:
August 13,
2010
Received:
May 20,
2010
Identification
Copyright
© 2011 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
