Eugene Wang, MD, Chaitanya Vadlamudi, MD, Elizabeth Zubowicz, MD. Medstar Georgetown-Washington Hospital Center
INTRODUCTION: The aim of this study is to evaluate short term morbidity, if any, of concomitant paraesophageal hernia repair (PHR) in patients undergoing laparoscopic sleeve gastrectomy (LSG). LSG is now the most widely used surgical intervention for morbid obesity, however significant concern exists about exacerbating or creating de novo gastroesophageal reflux disease (GERD) in these patients. Undiagnosed or untreated paraesophageal hernias may contribute to symptomatic GERD in these patients. They are present in 15 % of patients with body mass index (BMI) over 35 kg/m2. Intra-operative diagnosis of hiatal hernias is estimated to occur in 1/3 of LSG performed.
METHODS AND PROCEDURES: Retrospective, single center case control study (2016-2018) using data from Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Inclusion criteria: patients who underwent concurrent LSG and PHR. Primary endpoints: operative time (minutes), length of stay (LOS, days), BMI difference, emergency department (ED) visits, and mortality. Independent t-test was used for continuous data. Pearson’s chi-squared test was used for categorical data, reported as percentages.
RESULTS: Nine patients were identified with concurrent surgery by LSG and PHR, with 30 day follow-up. 562 control patients during this time period underwent LSG only. There were no statistically significant differences between the two groups’ co-morbidities in terms of diabetes, obstructive sleep apnea, GERD and hypertension. The LSG and PHR group was approached robotically 77.7% of the time, which was more frequent than the LSG only group which was approached robotically 40.5% of the time, p = 0.024. The operative time for the LSG and PHR group was on average 134.2 ± 69.7 minutes, which was longer than the LSG only group, which averaged 101.4 ± 45.4 minutes, p = 0.062. There were no statistically significant differences between the two groups in terms of LOS 1.1 ± 0.3 vs 1.4 ± 1.9 days (p = 0.472), BMI difference post-surgery 3.0 ± 0.6 vs 3.3 ± 2.6 (p = 0.242), ED visits 11.1% vs 10.1% (p = 0.924), and mortality 0% vs 0% (p = 0.858).
CONCLUSION: Concurrent surgery with LSG and PHR is safe to perform during the same operation, with no statistical difference in LOS, weight loss, morbidity or mortality, and only had minimally longer operative times. Given the high incidence of reflux symptoms after LSG, future studies should investigate improvement with LSG and PHR as opposed to LSG alone in those with a concurrent paraesophageal hernia.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94761
Program Number: P108
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster