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
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.
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.
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.
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.
|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||
|Surgery Duration (Minutes)||213.6||182.7||p=0.086|
|% Intrathoracic Stomach||
|Mesh Reinforcement||4 (26.7%)||45 (91.8%)||p<0.001|
|Length of stay(days)||2.27||3.1||
|Complications||4 (26.7%)||45 (91.8%)||
|90-day Mortality||0||1 (2%)||
|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|
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