Faculty Collaboration Database

Impact of concurrent hiatal hernia repair during laparoscopic sleeve gastrectomy on patient-reported gastroesophageal reflux symptoms: a state-wide analysis. Surg Obes Relat Dis 2023 Jun;19(6):619-625

Date

01/01/2023

Pubmed ID

36586763

DOI

10.1016/j.soard.2022.12.021

Scopus ID

2-s2.0-85145694518 (requires institutional sign-in at Scopus site)   3 Citations

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.

Author List

Hider AM, Bonham AJ, Carlin AM, Finks JF, Ghaferi AA, Varban OA, Ehlers AP

Author

Amir Ghaferi MD President, Phys Enterprise & SAD Clinical Affairs in the Medical College Physicians Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Female
Gastrectomy
Gastroesophageal Reflux
Hernia, Hiatal
Herniorrhaphy
Humans
Laparoscopy
Male
Obesity, Morbid
Quality of Life
Retrospective Studies
Treatment Outcome