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.
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.
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.
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.
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- National trends in use and outcome of laparoscopic adjustable gastric banding.Surg Obes Relat Dis. 2009; 5: 150-155
- The gastric band: first-choice procedure for obesity surgery.World J Surg. 2009; 33: 2039-2048
- Improvement in comorbid illness after placement of the Swedish adjustable gastric band.Surg Obes Relat Dis. 2008; 4: S39-S46
- Radiologic and endoscopic evaluation for laparoscopic adjustable gastric banding: preoperative and follow-up.Obes Surg. 2001; 11: 594-599
- Is routine preoperative upper endoscopy in gastric banding patients really necessary?.Obes Surg. 2006; 16: 45-47
- Hiatal hernia repair at the initial laparoscopic adjustable gastric band operation reduces the need for reoperation.Surg Endosc. 2008; 22: 1035-1041
- Upper gastrointestinal investigations before gastric banding.Surg Endosc. 2010; 24: 1025-1030
- Results and complications after Swedish adjustable gastric banding—10 years' experience.Obes Surg. 2009; 19: 1636-1641
- Esophageal anatomy and function in laparoscopic gastric restrictive bariatric surgery: implications for patient selection.Obes Surg. 1998; 8: 199-206
- Laparoscopic adjustable gastric banding in 1,791 consecutive obese patients: 12-year results.Obes Surg. 2007; 17: 168-175
- Symmetrical pouch dilatation after laparoscopic adjustable gastric banding: incidence and management.Obes Surg. 2008; 18: 1104-1108
- Crural repair permits morbidly obese patients with not large hiatal hernia to choose laparoscopic adjustable banding as a bariatric surgical treatment.Obes Surg. 2008; 18: 583-588
- Laparoscopic gastric banding and crural repair in the obese patient with a hiatal hernia.Obes Surg. 2003; 13: 772-775
- The SAGES Bariatric Surgery Outcome Initiative.Surg Endosc. 2005; 19: 1429-1438
- Use and outcomes of laparoscopic versus open gastric bypass at academic medical centers.J Am Coll Surg. 2007; 205: 248-255
- Applying the 3M All Patient Refined Diagnosis Related Groups Grouper to measure inpatient severity in the VA.Med Care. 2003; 41: II103-II110
- Simultaneous paraesophageal hernia repair and gastric banding.Obes Surg. 2005; 15: 435-438
- Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database.Surg Obes Relat Dis. 2010; 6: 347-355
- Upper gastrointestinal symptoms and associated disorders in morbidly obese patients: a prospective study.Dig Dis Sci. 2009; 54: 1243-1246
- Clinical utility of endoscopy and barium swallow x-ray in the diagnosis of sliding hiatal hernia in morbidly obese patients: a study before and after gastric bypass.Obes Surg. 2009; 23: S183-S196
- Endoscopy plays an important preoperative role in bariatric surgery.Obes Surg. 2004; 14: 1367-1372
- Preoperative upper gastrointestinal endoscopy in obese patients undergoing bariatric surgery: is it necessary?.Surg Obes Relat Dis. 2008; 4 (141): 144-150
- Routine preoperative upper endoscopy for laparoscopic gastric bypass: is it necessary?.Am Surg. 2004; 70: 684-686
- Treatment of morbid obesity and gastroesophageal reflux with hiatal hernia by Lap-Band.Obes Surg. 1999; 9: 396-398
- Initial experience with laparoscopic crural closure in the management of hiatal hernia in obese patients undergoing sleeve gastrectomy.Obes Surg. 2010; 20: 1149-1153
- Diagnosis and treatment of atypical presentations of hiatal hernia following bariatric surgery.Obes Surg. 2010; 20: 386-392
- Laparoscopic hiatal hernia repair with human acellular dermal matrix patch: our initial experience.Am J Surg. 2006; 192: 767-772
- Revisional bariatric surgery for failed restrictive procedures.Surg Obes Relat Dis. 2008; 4: 581-586
Published online: August 27, 2010
Accepted: August 13, 2010
Received: May 20, 2010
© 2011 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.