Does Simultaneous Hiatal Hernia Repair With Laparoscopic Roux-en-Y Gastric Bypass Effect Outcomes?

Kunoor Jain-spangler, MD, Jin Yoo, MD, Alfonso Torquati, MD MSci, Dana Portenier, MD, Ranjan Sudan, MD, Aurora D Pryor, MD. Duke University Medical Center; Stony Brook University Medical Center


Objective: The purpose of this study was to identify differences in outcomes for patients undergoing laparoscopic Roux-en-Y Gastric Bypass (LRYGB) with simultaneous hiatal hernia repair (HHR) as compared with a matched cohort of patients undergoing LRYGB alone. Patients presenting for LRYGB often have hiatal hernias, either known or incidentally discovered. We feel the hernia should be repaired for appropriate pouch sizing and to minimize long-term complications due to an incompetent GE junction or sliding hernia. Furthermore, from the acute postoperative standpoint, HHR helps minimize tension on the gastrojejunal anastomosis, potentially reducing leak risk.
Methods and Procedures: A retrospective cohort review was performed of MetaBarR (IRB Pro00003715), a secure bariatric database created and maintained by the Duke University Metabolic and Weight Loss Surgery Center, in which anthropometric data is collected prospectively. We compared data and outcomes for 59 patients from July 2009 to July 2011 who had LRYGB with simultaneous HHR with a matched cohort of patients in the same time period who had standard LRYGB with no additional procedure. Patients were matched by preoperative BMI, ASA class, age, sex and race. When performed, HHR began with circumferential crural dissection and utilized interrupted permanent sutures for primary cruroplasty. Biologic mesh was placed in 11 patients with larger defects, including large paraesophageal hernia, in addition to primary repair. Data were analyzed using student’s t-test.
Results: As shown in Table I, patients undergoing LRYGB with HHR who are demographically similar to patients undergoing LRYGB alone demonstrated no significant differences in estimated blood loss, hospital stay or weight loss. Operative time was significantly longer (p=0.03). Gastrojejunal leak rate was 0% in both groups, however the incidence of marginal ulcer was higher in the control group (3 vs. 0) without reaching statistical significance. The addition of mesh, which is indicative of larger hernia in our practice, was not significantly different than the no mesh group.
Conclusions: Data concerning simultaneous LRYGB and HH repair is sparse and consists primarily of case reports and series. The data we present here show the safety of performing these procedures together in appropriately selected patients, even with large paraesophageal hernia. The trend towards decreased marginal ulcers may be due to smaller pouch size in hernia repair patients.

Table I. Patient Demographics and Outcomes

EWL= estimated weight loss; *denotes statistically significant value

Session Number: Poster – Poster Presentations
Program Number: P247
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