Abstract
Background
Concurrent hiatal hernia repair (HHR) during laparoscopic sleeve gastrectomy (LSG)
may improve gastroesophageal reflux disease (GERD) symptoms. However, patient-reported
outcomes are limited, and the influence of surgeon technique remains unclear.
Objectives
To assess patient-reported GERD severity before and after LSG with and without concomitant
HHR.
Setting
Teaching and non-teaching hospitals participating in a state-wide quality improvement
collaborative.
Methods
Using a state-wide bariatric-specific data registry, all patients who underwent a
primary LSG between 2015 and 2019 who completed a baseline and 1 year validated GERD
health related quality of life (GERD-HRQL) survey were identified (n = 11,742). GERD
severity at 1 year as well as 30-day risk-adjusted adverse events was compared between
patients who underwent LSG with or without HHR. Results were also stratified by anterior
versus posterior HHR.
Results
A total of 4015 patients underwent a LSG-HHR (34%). Compared to patients who underwent
LSG without HHR, LSG-HHR patients were older (47.8 yr versus 44.6 yr; P < .0001), had a lower preoperative body mass index (BMI) (45.8 kg/m2 versus 48 kg/m2; P < .0001) and more likely to be female (85.2% versus 77.6%, P < .0001). Patients who underwent a posterior HHR (n = 3205) experienced higher rates
of symptom improvement (69.5% versus 64.0%, P = .0014) and lower rates of new onset symptoms at 1 year (28.2% versus 30.2%, P = .0500). Patients who underwent an anterior HHR (n = 496) experienced higher rates
of hemorrhage and readmissions with no significant difference in symptom improvement.
Conclusions
Concurrent posterior hiatal HHR at the time of sleeve gastrectomy can improve reflux
symptoms. Patients undergoing anterior repair derive no benefit and should be avoided.
Keywords
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Article info
Publication history
Published online: December 11, 2022
Accepted:
December 2,
2022
Received:
July 28,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Comment on: Impact of concurrent hiatal hernia repair during laparoscopic sleeve gastrectomy on patient-reported gastroesophageal reflux symptomsSurgery for Obesity and Related Diseases
- PreviewAs laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric surgery in the US, much attention has been on better understanding the technical conduct of the operation and patient selection. Since its widespread adoption, changes in technique have focused on important aspects of sleeve construction, including proximity to the antrum, luminal diameter, attention to fundus resection, staple heights, and staple-line reinforcement, among other considerations. One particular area of the operation that still remains under active investigation is the identification of, and repair of, hiatal hernia at the time of the operation.
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