Concurrent Laparoscopic Roux-en-Y Gastric Bypass with Paresophageal Hiatal Hernia Repair

Agustin Duro, MD, Fernando G Wright, MD, Maria M Pardo, MD, Santiago Lenzi, MD, Pablo J Castellaro, MD, Juan R Medici, MD, Axel F Beskow, MD, Demetrio Cavadas, MD, PhD. Hospital Italiano de Buenos Aires

Roux-en-Y gastric bypass (RYGB) appears to be the procedure of choice for the treatment of patients with morbid obesity and gastroesophageal reflux disease (GERD), especially in the presence of a hiatal hernia. In the other hand, Nissen fundoplication for the treatment of hiatal hernias is associated with unacceptably high recurrence rates in obese patients.

This video shows a 61-year-old woman who consulted for morbid obesity and typical GERD symptoms. She had a BMI of 37 and history of hypertension, insulin resistance and dyslipidemia. A CT scan, barium swallow and endoscopy revealed a large paraesophageal hiatal hernia. Simultaneous laparoscopic hiatal hernia repair and RYGB were performed. She had no postoperative complications and was discharged on the second postoperative day. In 8 months, she has already achieved an excess weight loss of 89% with no GERD symptoms recurrence.

Concomitant paraesophageal hiatal hernia repair with RYGB seems to be safe and feasible for the treatment of both morbid obesity and GERD.

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