Paraesophageal Hernia Repair With Gastric Bypass As a Parietal Cell Separating Procedure: A Novel Treatment for Idiopathic Pulmonary Fibrosis

Kalman P Bencsath, MD, Roberto Ramirez, MD, Philip Schauer, MD, Stacy Brethauer, MD, Bipan Chand, MD, Steven Shay, MD, Matthew Kroh, MD. Cleveland Clinic


Idiopathic Pulmonary Fibrosis is a relatively rare, but progressive and incapacitating disease, frequently leading to end-stage lung disease and the need for lung transplantation. Only recently, gastroesophageal reflux has been identified as a leading etiology, with strong evidence that anti-reflux surgery may halt disease progression even in patients with end-stage disease, and may prevent graft failure in post-transplant patients.

We present the case of MP, a 53 year old morbidly obese female with a four year history of progressive pulmonary fibrosis and a type III paraesophageal hernia with significant reflux on workup.  Here we demonstrate a hiatal hernia repair with biologic mesh reinforcement, as well as a gastric bypass. The gastric bypass in this scenario serves three functions: parietal cell separation will prevent acid production within the gastric pouch, the long roux limb will prevent bile reflux, and the gastric bypass also serves as a weight loss operation with the intent to reduce her risk of recurrent hernia as well as reduce her comorbidities. We demonstrate this technique as a safe alternative to traditional anti-reflux operations as a means of providing lasting prevention of gastroesophageal reflux. We further emphasize that any patient with idiopathic pulmonary fibrosis, whether pre- or post-transplant, should undergo workup and consideration for anti-reflux surgery.

Session Number: VidTV2 – Video Channel Rotation Day 2
Program Number: V105

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