Highlights
- •Concurrent hiatal hernia repair with SG is associated with higher risk of reoperation
- •Concurrent hiatal hernia repair with RYGB is associated with higher risk of endoscopy
Abstract
Background
Hiatal hernias are often repaired concurrently with bariatric surgery to reduce risk
of gastroesophageal reflux disease–related complications.
Objectives
To examine the association between concurrent hiatal hernia repair (HHR) and bariatric
outcomes.
Setting
A 2010–2017 U.S. commercial insurance claims data set.
Methods
We conducted a retrospective cohort study. We identified adults who underwent sleeve
gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) alone or had bariatric surgery
concurrently with HHR. We matched patients with and without HHR and followed patients
up to 3 years for incident abdominal operative interventions, bariatric revisions/conversions,
and endoscopy. Time to first event for each outcome was compared using multivariable
Cox proportional hazards modeling.
Results
We matched 1546 SG patients with HHR to 3170 SG patients without HHR, and we matched
457 RYGB patients with HHR to 1156 RYGB patients without HHR. A total of 73% had a
full year of postoperative enrollment. Patients who underwent concurrent SG and HHR
were more likely to have additional abdominal operations (adjusted hazard ratio [aHR],
2.1; 95% CI, 1.5–3.1) and endoscopies (aHR, 1.5; 95% CI, 1.2–1.8) but not bariatric
revisions/conversions (aHR, 1.7; 95% CI, .6–4.6) by 1 year after surgery, a pattern
maintained at 3 years of follow-up. Among RYGB patients, concurrent HHR was associated
only with an increased risk of endoscopy (aHR, 1.4; 95% CI, 1.1–1.8)) at 1 year of
follow-up, persisting at 3 years.
Conclusions
Concurrent SG/HHR was associated with increased risk of some subsequent operative
and nonoperative interventions, a pattern that was not consistently observed for RYGB.
Additional studies could examine whether changes to concurrent HHR technique could
reduce risk.
Keywords
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Article info
Publication history
Published online: September 02, 2020
Accepted:
August 24,
2020
Received:
May 5,
2020
Footnotes
Funding Information: The Bariatric CHOICE (Comparative Health Outcomes Using Insurance Claims to Study Effectiveness) project was supported through a grant from NIH/NIDDK (R01 DK112750; Lewis PI).
Identification
Copyright
© 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
