Jai Prasad, MD, Claire I Lauer, MD, Jacob A Petrosky, MD, David K May, DO, Marcus Fluck, James T Dove, Jon D Gabrielsen, MD, Anthony T Petrick, David M Parker, MD. Geisinger Medical Center
Introduction
We hypothesize that laparoscopic paraesophageal hernia repair with concurrent roux-en-y gastric bypass (LRYGB/PEH) can be performed with no increase in morbidity and fewer recurrences than laparoscopic paraesophageal hernia repair (LPEHR) in patients with morbid obesity.
Methods
All patients referred for paraesophageal hernia with a BMI (Body Mass Index) >35 from 01/2008 to 06/2017 were included. Patients with type I hiatal hernia or previous foregut surgery were excluded. Primary outcome measure was recurrence. Secondary outcome measures were perioperative outcomes. Data were analyzed using unpaired t-test and Fisher’s Exact test.
Results
A total of 64 patients underwent laparoscopic paraesophageal hernia repair (LPEHR) or laparoscopic roux-en-y gastric bypass combined with paraesophageal hernia repair (LRYGB/PEH). Patients who underwent LRYGB/PEH were younger with a higher BMI. There was no significant difference in perioperative morbidity, mortality, or recurrence.
Conclusions
Combined LRYGB/PEH can be performed safely with no increase in perioperative morbidity or mortality with equivalent recurrence rates. This may be ideal given the metabolic benefit of LRYGB.
| LRYGB/PEH(n=15) | LPEHR(n=49) | ||
| Age | 54.5 | 65.6 |
p<0.001 |
| Female |
14 (93.3%) |
39 (79.5%) | p=0.434 |
| Pre-op BMI | 43.1 | 38.4 | p<0.001 |
| Diabetes | 4 (26.7%) | 9 (18.3%) | p=0.483 |
| Hypertension | 10 (66.7%) | 36 (73.4%) | p=0.744 |
| Dyslipidemia | 7 (46.7%) | 25 (51%) | p=1.000 |
| Pre-op High dose PPI |
8 (53.3%) |
36 (73.4%) | p=0.203 |
| Surgery Duration (Minutes) | 213.6 | 182.7 | p=0.086 |
| EBL (ml) | 19.2 | 26.5 |
p=0.622 |
| % Intrathoracic Stomach |
57.5 |
61 | p=0.610 |
| Mesh Reinforcement | 4 (26.7%) | 45 (91.8%) | p<0.001 |
| Length of stay(days) | 2.27 | 3.1 |
p=0.601 |
| Complications | 4 (26.7%) | 45 (91.8%) |
p<0.001 |
| 90-day Mortality | 0 | 1 (2%) |
p=1.000 |
| Recurrence | 2 (13.3%) | 13 (26.5%) | p=0.488 |
| Follow up (months) | 29.3 | 36.2 | p=0.402 |
| Post-op high dose PPI | 6 (40%) | 10 (20%) | p=0.173 |
| %EBWL | 57.3% | 15.2% | p<0.001 |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87837
Program Number: P408
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster