Laparoscopic Roux-en-Y Gastric Bypass with Primary Repair for Symptomatic Giant Paraesophageal Hernia in Morbid Obesity: Killing Two Birds with One Stone

INTRODUCTION: Primary repair of giant paraesophageal hernias is associated with high failure rates in the morbidly obese patients. A surgical approach to addressing both paraesophageal hernia and morbid obesity has not been explored in the surgical literature.

METHODS: Three morbidly obese females (ages 39, 52 and 58 years with BMIs 46.8, 50 and 52.3 respectively) with symptomatic giant paraesophageal hiatal hernias underwent laparoscopic repair of hiatal hernia (sac excision and primary repair) and Roux-en-Y gastric bypass as a combined procedure.

RESULTS: There was no intra-operative and post-operative morbidity with a mean operative time of 241 minutes and mean hospital stay of 4 days. One patient required endoscopic balloon dilatation of the gastrojejunostomy. At 12 month follow-ups, all three patients remain asymptomatic and off all antireflux medications, and have achieved significant weight loss (54.3%; 47.9% and 36.0% of their excess body weight respectively for a BMI of 32.8, 36.2 and 40.7).

CONCLUSIONS: A combined hiatal hernia repair and Roux-en-Y gastric bypass should be considered as primary modality for treatment of symptomatic giant paraesophageal hernias in the morbidly obese.

Session: Poster

Program Number: P023

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