Log in

SAGES

Reimagining surgical care for a healthier world

You are here: Home / Abstracts / Paraesophageal hernia repair in the morbidly obese patient: Is a combined roux-en-y gastric bypass and paraesophageal hernia repair ideal?

Paraesophageal hernia repair in the morbidly obese patient: Is a combined roux-en-y gastric bypass and paraesophageal hernia repair ideal?

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.

Table 1. Demographics and outcomes
  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

93
sages_adbutler_leaderboard