Impact On Perioperative Outcomes of Concomitant Hiatal Hernia Repair with Laparoscopic Gastric Bypass

Vishal M Kothari, MD, Oleg Dolghi, MD, Jason F Reynoso, MD, Elizabeth M Schmidt, MD, Dmitry Oleynikov, MD. University of Nebraska Medical Center, Omaha, NE.

BACKGROUND: Laparoscopic hiatal hernia repair (LHHR) during laparoscopic Roux-en-y gastric bypass (LRYGB) is controversial, and data on this topic is limited. In this study, the safety of concomitant LHHR with LRYGB is evaluated.
METHODS: This study is a multi-center, retrospective analysis utilizing a large administrative database. The University HealthSystem Consortium (UHC) is an alliance of more than 100 academic medical centers and nearly 200 affiliate hospitals. UHC’s Clinical DataBase/Resource Manager (CDB/RM) allows comparison of patient-level risk adjusted outcomes for performance improvement. Data from the CDB/RM was queried using International Classification of Diseases (ICD-9) codes for LRYGB, LHHR and diagnosis of hiatal hernia from 2006 through 2010. Main outcome measures analyzed were mortality, morbidity, 30-day readmission, overall length of stay (LOS) and cost.
RESULTS: 33,717 patients without hiatal hernia underwent LRYGB between October 2006 and January 2010. During this same time period, 644 patients underwent concomitant LRYGB and LHHR. 1589 patients with hiatal hernias who underwent did not have LHHR. Comparison of patients who underwent LRYGB and simultaneous LHHR with those who had LRYGB without a diagnosis of hiatal hernia demonstrated no significant difference in mortality (LRYGB HHR 0% vs. LRYGB 0.12%; p=0.77), morbidity (LRYGB LHHR 9.01% vs. LRYGB 7.75%; p=0.27), LOS (LRYGB LHHR 2.64 ± 2.05 days vs. LRYGB 2.83 ± 4.98 days; p=0.33), 30 day readmission (LRYGB LHHR 1.55% vs. LRYGB 2.35%; p=0.19), and cost (LRYGB LHHR $15,894 ± 8,076 vs. LRYGB $15,280 ± 19,011; p=0.41) . Comparison of patients with a diagnosis of hiatal hernia who underwent LRYGB and simultaneous LHHR versus those who had LRYGB without LHHR demonstrated no significant difference in mortality (LRYGB LHHR 0% vs. LRYGB no LHHR 0.06%; p=1), morbidity (LRYGB HHR 9.01% vs. LRYGB no LHHR 9.06%; p=1), LOS (LRYGB LHHR 2.64 ± 2.05 days vs. LRYGB no LHHR 2.97 ± 5.29 days; p=0.12), 30 day readmission (LRYGB LHHR 1.55% vs. LRYGB no LHHR 2.27%; p=0.33), and cost (LRYGB LHHR $15,894 ± 8,076 vs. LRYGB no LHHR $16,109 ± 22,643; p=0.81).
CONCLUSION: Presence of a hiatal hernia does not impact overall perioperative outcomes in LRYGB. LHHR performed simultaneously with LRGYB does not increase morbidity, mortality, length of stay, or cost. Hiatal hernia repair concomitant with laparoscopic gastric bypass is safe and efficacious and can be performed without subjecting the patient to increased risk or cost.