Hiatal Hernia Repair in Laparoscopic Roux-en-Y Gastric Bypass Significantly Improves Reflux But Not Weight Loss

Daniel Moon, MD, Ahmad Bashir, MD, Jennifer Higa, BS MPH, Saber Ghiassi, MD MPH, Tienchin Ho, MD FACS, Keith Boone, MD FACS, Kelvin Higa, MD FACS. Department of Surgery, UCSF- Fresno Medical Education Program

Introduction: Hiatal hernia repair during laparoscopic adjustable gastric banding has been shown to improve outcomes and surgical reoperations. We questioned if hiatal hernia repair during laparoscopic Roux-en-Y gastric bypass (LRYGB) had the same effect.

Methods: We compared a 2006 cohort without routine hiatus dissection (Group 1) to a 2008 cohort with routine dissection (Group 2) for weight loss and reflux symptoms. All procedures were performed by a single surgeon. Hiatal dissections were complete and hiatal hernias, when present, were repaired by posterior crural approximation. Weight loss data was obtained from measurements at post-op office visits and analyzed using Student’s t-test. Reflux data was obtained from a mailed survey and analyzed using Chi-squared test.
 

Results: There were a total of 385 patients from Group 1 and 369 patients from Group 2 available for study. Weight loss data was available on 136 patients at two years and 92 patients at three years post-op for Group 1, and for 105 patients at two years and 20 patients at three years post-op for Group 2. Percent excess weight loss did not differ between groups (Table 1). Return percentage for GERD Survey was 26% from Group 1, and 33% from Group 2. Reflux was reported in more Group 1 patients than Group 2 patients, though daily reflux medication use was similar (Table 2).

Conclusions: Excess weight loss at 2 and 3 years is unchanged by the addition of routine hiatus dissection to LRYGB, however, GERD symptoms were improved by addition of this practice.

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