John DeBarros, MD, Michael J Orris, DO, Catherine Ho, DO, Thomas Buddensick, MD. Weightless Institute of Arizona
Background: The Sleeve Gastrectomy (LSG) is the most popular procedure worldwide to treat obesity. Among those that are obese, GERD has a prevalence of 39.8 percent. Many surgeons do not perform LSG in these patients because only 34.6 percent of symptomatic patients showed resolution of GERD-like symptoms after concomitant sleeve gastrectomy with hiatal hernia repair.
Many surgeons perform the gastric bypass on GERD patients with hiatal hernias because they believe its superior for the resolution of GERD. When they do this they overlook the many long term complication associated with gastric bypass. Also, many patients do not want the gastric bypass under any circumstances. Surgeons need to be open to finding better way to reduce the high recurrent rates of GERD after LSG.
Materials and Methods: This is a single institution, multi-surgeon, retrospective study involving 73 morbidly obese patients in a prospectively kept data base from January of 2015 through July of 2017. These patients all had GERD with preoperatively identified hiatal hernias on EGD. All patients were dependent on anti-reflux medications. There were 9 (12.4%) males and 64 (87.6%) females. BMI ranged from 35 to 63. Hiatal hernias measured from 2cm to 8cm.
All LSG patients received a primary crural closure, with or without Gore Bio A mesh placement, at least 6 weeks prior to the sleeve gastrectomy. Post-operatively, patients were interviewed for GERD symptomatology and anti-reflux medication dependency.
Results: Of the 73 patients, 53 (72.60%) patients had resolution of GERD-like symptoms and off all anti-reflux medications after the staged hiatal hernia repair and sleeve gastrectomy. 13 patients (17.80%) had improvement of GERD but still dependent on anti-reflux medication. 7 patients (9.60%) had no resolution or improvement of GERD. There was one post-operative complication of laryngospasm with pulmonary edema status post extubation. There were no mortalities in the series.
Conclusions: In this study, staged hiatal hernia repair, at least 6 weeks prior to sleeve gastrectomy, doubled the published rate of GERD resolution from 34% to 73%. 90% showed improvement in symptoms at one year. This rate is comparable to GERD resolution after gastric bypass. This may be an alternative approach to hiatal hernias in the morbidly obese patient with gastroesophageal reflux disease who do not want a gastric bypass.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87851
Program Number: P638
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster