Ramachandra Kolachalam, MD, Francisco Igor Macedo, MD, Mia Mowzoon, BSc, Vijay K Mittal, MD, Mubashir Sabir, MD. Providence Hospital and Medical Centers/ Michigan State University
Background: Laparoscopic sleeve gastrectomy (LSG) has rapidly gained worldwide popularity, however it is associated with worsening postoperative reflux in some patients. Experience with simultaneous LSG and hiatal hernia (HH) repair has been reported, however there is ongoing debate that the development of gastroesophageal reflux disease (GERD) following LSG may not be due to the procedure itself, but due to the patient’s pre-existing modifiable risk factors. Herein, we aim to analyze the clinical outcomes of laparoscopic HH repair after LSG.
Methods: We retrospectively reviewed our experience with obese and morbidly obese patients with prior LSG undergoing laparoscopic HH repair from August 2010 to July 2016. Patient demographics and clinical outcomes including mortality, length of stay (LOS), readmission rates, reoperation and complications were described. Patients were contacted to determine symptomatic relief, weight loss and overall satisfaction using a validated 13-point questionnaire.
Results: A total of 32 patients underwent laparoscopic HH repair: 23 (71.9%) patients underwent simultaneous HH repair and LSG and 9 (28.1%) patients underwent HH repair after LSG. Among these patients, 8 (88.9%) patients were females, mean age and preoperative BMI were 43 ± 8.9 years and 45.9 ± 5.4 kg/m2, respectively. Repair was performed with Bio-A®Gore® mesh (W.L Gore Inc, Newark, DE) and primary cruroplasty in 6 (66.7%) and 3 (33.3%) cases, respectively. All patients had a normal upper gastrografin swallow study on postoperative day 1. No mortality or need for reoperation was reported. Mean LOS was 1.3 ± 0.7 days, and 1 (11.1%) patient was readmitted with hematemesis secondary to gastric ulcers. During follow-up, there was decrease in GERD score (p=0.03), and 80% of patients reported symptomatic relief after HH.
Conclusion: The association between LSG and GERD poses a complex relationship that may involve a reduction in gastric compliance and increased postprandial intragastric pressure. This is the first study to analyze the outcomes of bariatric patients with prior LSG undergoing laparoscopic HH repair. It offers a safe, feasible two-stage approach in the management of persistent GERD in well-selected obese and morbidly obese patients. Symptomatic relief was experienced by most patients during follow-up survey. A two-stage approach, rather than routine simultaneous LSG and HH repair, may be an interesting option to avoid unnecessary mesh use and to triage patients who successfully presented GERD relief after weight loss.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79747
Program Number: P500
Presentation Session: Poster (Non CME)
Presentation Type: Poster