Jorge Saba1,2,3, Magdalena Bravo4, Eugenio Rivas5, Roberto Fernández5, Alberto Pérez-Castilla5, Jorge Zajjur5. 1. Service of Bariatric and Metabolic Surgery, Indisa Clinic, Avenida Santa María 1810, 7520440, Santiago, Chile. doctor@jorgesaba.cl. 2. Surgery Service, Dipreca Hospital, Avenida Vital Apoquindo 1200, 7601003, Santiago, Chile. doctor@jorgesaba.cl. 3. School of Medicine, Diego Portales University, Dipreca Hospital, Avenida Vital Apoquindo 1200, 7601003, Santiago, Chile. doctor@jorgesaba.cl. 4. Surgery Service, Luis Tisné Hospital, Avenida Las Torres 5150, 7930124, Santiago, Chile. 5. Service of Bariatric and Metabolic Surgery, Indisa Clinic, Avenida Santa María 1810, 7520440, Santiago, Chile.
Abstract
PURPOSE: After laparoscopic sleeve gastrectomy (LSG), several studies have reported an increase in the incidence of gastroesophageal reflux (GERD). The etiopathogenesis of GERD post-LSG is multifactorial, and hiatal hernia (HH) is one of them. The primary objective was to measure the incidence of de novo HH post-LSG. The secondary objectives were to relate the presence of HH with GERD, the chronic use of proton pump inhibitors (PPI), and the time elapsed from LSG. MATERIALS AND METHODS: A surgical evaluation of the crura after LSG was performed. A retrospective cohort study of 74 consecutive patients with history of LSG submitted to an intra-abdominal surgery that allowed the evaluation of the crura. RESULTS: Of a total of 74 patients, 51 were included. At the time of surgery, 37 patients (72.5%) had a HH; 24 patients (47.1%) had GERD, and 23 patients (45.1%) were frequently using PPI. When patients with HH and those without HH were compared, GERD was observed in 56.8% versus 21.4% (p = 0.01) and frequent consumption on PPI was found in 54.1% versus 21.4% (p = 0.02). According to the data of LSG, with a follow-up of < 18 months, 60% presented HH; meanwhile, with a follow-up of > 18 months, 84.6% presented HH (p = 0.02). CONCLUSIONS: Patients submitted to LSG showed a high incidence of de novo HH. HH was associated with a higher incidence of GERD and PPI dependence. The longer the time elapsed from the LSG, the greater the incidence of HH.
PURPOSE: After laparoscopic sleeve gastrectomy (LSG), several studies have reported an increase in the incidence of gastroesophageal reflux (GERD). The etiopathogenesis of GERD post-LSG is multifactorial, and hiatal hernia (HH) is one of them. The primary objective was to measure the incidence of de novo HH post-LSG. The secondary objectives were to relate the presence of HH with GERD, the chronic use of proton pump inhibitors (PPI), and the time elapsed from LSG. MATERIALS AND METHODS: A surgical evaluation of the crura after LSG was performed. A retrospective cohort study of 74 consecutive patients with history of LSG submitted to an intra-abdominal surgery that allowed the evaluation of the crura. RESULTS: Of a total of 74 patients, 51 were included. At the time of surgery, 37 patients (72.5%) had a HH; 24 patients (47.1%) had GERD, and 23 patients (45.1%) were frequently using PPI. When patients with HH and those without HH were compared, GERD was observed in 56.8% versus 21.4% (p = 0.01) and frequent consumption on PPI was found in 54.1% versus 21.4% (p = 0.02). According to the data of LSG, with a follow-up of < 18 months, 60% presented HH; meanwhile, with a follow-up of > 18 months, 84.6% presented HH (p = 0.02). CONCLUSIONS:Patients submitted to LSG showed a high incidence of de novo HH. HH was associated with a higher incidence of GERD and PPI dependence. The longer the time elapsed from the LSG, the greater the incidence of HH.