Maher El Chaar1, George Ezeji2, Leonardo Claros2, Maureen Miletics2, Jill Stoltzfus3. 1. Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, The Medical School of Temple University, St Luke's University and Health Network, 240 Cetronia Road, Suite 205, North Allentown, PA, 18104, USA. Maher.Elchaar@sluhn.org. 2. Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, The Medical School of Temple University, St Luke's University and Health Network, 240 Cetronia Road, Suite 205, North Allentown, PA, 18104, USA. 3. Research Institute and Medical School of Temple University, St. Luke's University Health Network, Allentown, PA, USA.
Abstract
BACKGROUND: Laparoscopic sleeve gastrectomy (SG), while generally safe and efficacious, may be complicated by gastroesophageal reflux disease (GERD) symptoms as well as the need for hiatus hernia (HH) repair. Identification and management of HH during SG and the effect of HH repair on GERD-related symptoms following SG are controversial. OBJECTIVE: This study aimed to evaluate HH repair during SG in morbidly obese patients and its short-term effect on GERD-related symptoms and other clinical outcomes. SETTING: University Hospital, United States METHODS: We retrospectively reviewed patients who underwent primary SG and HH repair. Outcomes included operative time, blood loss, postoperative excess weight loss (%EWL), and self-reported GERD symptoms using a health-related quality of life (HRQL) questionnaire. RESULTS: For a total of 338 patients, 99 patients (29 %) underwent SG in combination with HH repair; 56 patients (16 %) underwent anterior repair of HH (SG + HH), and 43 patients (13 %) underwent posterior repair with or without mesh placement (SG + paraesophageal hernia (PEH)). We found no significant differences in operative time or blood loss, with significantly higher %EWL at 6 months in SG + HH (n = 43) and SG + PEH (n = 32) compared to SG alone (n = 190). There was also a statistically significant improvement in postoperative GERD symptoms. Finally, SG + HH and SG + PEH patients reported greater satisfaction compared to SG patients (>93 versus 87 %). CONCLUSIONS: SG patients undergoing HH repair experienced higher %EWL, improved GERD symptoms, and greater satisfaction compared to SG alone in the short term. Further studies are needed to clarify long-term outcomes among patients undergoing SG in combination with HH repair.
BACKGROUND: Laparoscopic sleeve gastrectomy (SG), while generally safe and efficacious, may be complicated by gastroesophageal reflux disease (GERD) symptoms as well as the need for hiatus hernia (HH) repair. Identification and management of HH during SG and the effect of HH repair on GERD-related symptoms following SG are controversial. OBJECTIVE: This study aimed to evaluate HH repair during SG in morbidly obesepatients and its short-term effect on GERD-related symptoms and other clinical outcomes. SETTING: University Hospital, United States METHODS: We retrospectively reviewed patients who underwent primary SG and HH repair. Outcomes included operative time, blood loss, postoperative excess weight loss (%EWL), and self-reported GERD symptoms using a health-related quality of life (HRQL) questionnaire. RESULTS: For a total of 338 patients, 99 patients (29 %) underwent SG in combination with HH repair; 56 patients (16 %) underwent anterior repair of HH (SG + HH), and 43 patients (13 %) underwent posterior repair with or without mesh placement (SG + paraesophageal hernia (PEH)). We found no significant differences in operative time or blood loss, with significantly higher %EWL at 6 months in SG + HH (n = 43) and SG + PEH (n = 32) compared to SG alone (n = 190). There was also a statistically significant improvement in postoperative GERD symptoms. Finally, SG + HH and SG + PEH patients reported greater satisfaction compared to SG patients (>93 versus 87 %). CONCLUSIONS: SG patients undergoing HH repair experienced higher %EWL, improved GERD symptoms, and greater satisfaction compared to SG alone in the short term. Further studies are needed to clarify long-term outcomes among patients undergoing SG in combination with HH repair.
Authors: Patrice R Carter; Karl A LeBlanc; Mark G Hausmann; Kenneth P Kleinpeter; Sean N deBarros; Shannon M Jones Journal: Surg Obes Relat Dis Date: 2011-03-22 Impact factor: 4.734
Authors: Tiffany Jian Ying Lye; Kiat Rui Ng; Alexander Wei En Tan; Nicholas Syn; Shi Min Woo; Eugene Kee Wee Lim; Alvin Kim Hock Eng; Weng Hoong Chan; Jeremy Tian Hui Tan; Chin Hong Lim Journal: PLoS One Date: 2020-11-06 Impact factor: 3.240