Andrew J Long1, Paul R Burton2,3, Cheryl P Laurie2, Margaret L Anderson2, Geoff S Hebbard4, Paul E O'Brien2, Wendy A Brown2,3. 1. Centre for Obesity Research and Education, Monash University, Melbourne, 3004, Australia. ajlon1@student.monash.edu.au. 2. Centre for Obesity Research and Education, Monash University, Melbourne, 3004, Australia. 3. Monash University, Department of Surgery, The Alfred Hospital, 99 Commercial Rd, Melbourne, 3004, Australia. 4. Melbourne University, Department of Gastroenterology, Royal Melbourne Hospital, 300 Grattan St, Parkville, 3050, Australia.
Abstract
OBJECTIVE: The objective of the study is to identify the efficacy and safety of combining laparoscopic adjustable gastric banding with repair of large para-oesophageal hernias. BACKGROUND: Para-oesophageal hernias are more common in the obese with higher recurrence rates following repair. The effect and safety of combining para-oesophageal hernia repair with laparoscopic adjustable gastric banding is unknown. METHODS: One-hundred fourteen consecutive patients undergoing primary laparoscopic adjustable gastric banding with concurrent repair of a large para-oesophageal hernia were prospectively identified and matched to a control group undergoing primary laparoscopic adjustable gastric banding only. Weight loss and complication data were retrieved from a prospectively maintained database, and a standardised bariatric outcome questionnaire was used to assess post-operative symptoms, satisfaction with surgery and satiety scores. RESULTS: At a mean follow up of 4.9 ± 2.1 years, total weight loss was 16.4 ± 9.9% in the hernia repair group and 17.6 ± 12.6% in the control group (p = 0.949), with 17 vs. 11% loss to follow up rates (p = 0.246). No statistically significant difference in revisional surgery rate and symptomatic recurrence of hiatal hernia was documented in four patients in the hernia repair group (3.5%). No statistically significant difference in mean reflux (9.9 vs. 10.3, p = 0.821), dysphagia (20.7 vs. 20.1, p = 0.630) or satiety scores was identified. CONCLUSIONS: Concurrent repair of large para-oesophageal hiatal hernia and laparoscopic adjustable gastric banding placement is safe and effective both in terms of symptom control and weight loss over the intermediate term. In obese patients with large hiatal hernias, consideration should be given to combining repair of the hernia with a bariatric procedure.
OBJECTIVE: The objective of the study is to identify the efficacy and safety of combining laparoscopic adjustable gastric banding with repair of large para-oesophageal hernias. BACKGROUND:Para-oesophageal hernias are more common in the obese with higher recurrence rates following repair. The effect and safety of combining para-oesophageal hernia repair with laparoscopic adjustable gastric banding is unknown. METHODS: One-hundred fourteen consecutive patients undergoing primary laparoscopic adjustable gastric banding with concurrent repair of a large para-oesophageal hernia were prospectively identified and matched to a control group undergoing primary laparoscopic adjustable gastric banding only. Weight loss and complication data were retrieved from a prospectively maintained database, and a standardised bariatric outcome questionnaire was used to assess post-operative symptoms, satisfaction with surgery and satiety scores. RESULTS: At a mean follow up of 4.9 ± 2.1 years, total weight loss was 16.4 ± 9.9% in the hernia repair group and 17.6 ± 12.6% in the control group (p = 0.949), with 17 vs. 11% loss to follow up rates (p = 0.246). No statistically significant difference in revisional surgery rate and symptomatic recurrence of hiatal hernia was documented in four patients in the hernia repair group (3.5%). No statistically significant difference in mean reflux (9.9 vs. 10.3, p = 0.821), dysphagia (20.7 vs. 20.1, p = 0.630) or satiety scores was identified. CONCLUSIONS: Concurrent repair of large para-oesophageal hiatal hernia and laparoscopic adjustable gastric banding placement is safe and effective both in terms of symptom control and weight loss over the intermediate term. In obesepatients with large hiatal hernias, consideration should be given to combining repair of the hernia with a bariatric procedure.
Authors: Ankit D Patel; Edward Lin; Nathaniel W Lytle; Juan P Toro; Jahnavi Srinivasan; Arvinpal Singh; John F Sweeney; S Scott Davis Journal: Surg Endosc Date: 2014-08-27 Impact factor: 4.584
Authors: Umer I Chaudhry; Brendan M Marr; Sylvester N Osayi; Dean J Mikami; Bradley J Needleman; W Scott Melvin; Kyle A Perry Journal: Surg Obes Relat Dis Date: 2014-02-10 Impact factor: 4.734