Anna R Ibele, MD, Paige L Martinez, MS, Chelsea M Allen, PhD, Mark A Taylor, MD, Matthew Kingsbury, BS, Ellen H Morrow, MD, Robert E Glasgow, MD, Eric T Volckmann, MD. University of Utah
INTRODUCTION: Hiatal hernia repair at the time of bariatric surgery adds additional operative time and technical complexity to the operation. While early postoperative complications of conventional hiatal hernia repair and paraesophageal hernia repair performed with fundoplication are well described, the incidence of perioperative complications in patients undergoing hiatal dissection and closure in conjunction with sleeve gastrectomy has not been established.
We wished to determine whether performing a hiatal hernia repair in conjunction with sleeve gastrectomy was associated with increased risk of adverse perioperative outcomes.
METHODS AND PROCEDURES: Registry data from the American College of Surgeons’ MBSAQIP database from January 2015 to December 2016 was reviewed to assess for the presence of a hiatal or paraesophageal hernia repair performed in conjunction with a sleeve gastrectomy. Patients were grouped into two cohorts depending on the presence or absence of hiatal dissection at the time of sleeve gastrectomy. Regression models were constructed to assess for incidence of postoperative nausea and vomiting with nutritional depletion, sepsis, stricture, anastomotic leak, need for therapeutic endoscopy, 30 day readmission and 30 day reoperation rates. Depending on the type of postoperative outcome variable, logistic regression (binary response) or Poisson regression (count response) was used, controlling for demographic covariates.
RESULTS: In the two year period, 44,291 patients underwent sleeve gastrectomy with hiatal hernia repair and 155,477 underwent sleeve gastrectomy without hiatal dissection. The addition of a hiatal repair to a sleeve gastrectomy was associated with a 14% increase in the odds of diagnosis of postoperative nausea and vomiting with nutritional depletion (OR: 1.14; 95% CI: 1.03, 1.26/p=0.010), a 10% increase in the odds of 30 day readmission (OR 1.10; 95% CI: 1.03, 1.17/p=0.003) and a 17% increased odds of 30 day reoperation (OR 1.17; 95% CI: 1.04, 1.31/p=0.010). There was no significant difference in rates of sepsis, stricture, anastomotic leak or need for therapeutic endoscopy.
CONCLUSION: Hiatal hernia repair performed in conjunction with sleeve gastrectomy imparts an increased risk of nausea and vomiting with nutritional depletion, 30 day readmission, and 30 day reoperation compared to patients having sleeve gastrectomy performed without hiatal hernia repair. In patients with a hiatal hernia, the decision to perform sleeve gastrectomy with hiatal repair should be undertaken with caution because of these increased perioperative risks.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94745
Program Number: P143
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster