Joshua Hefler, MD1, Jerry Dang, MD1, Noah Switzer, MD, MPH2, Valentin Mocanu, MD1, Daniel W Birch, MD, MSc, FRCSC1, Shazheer Karmali, MD, MPH, FRCSC1. 1University of Alberta, 2Ohio State University
INTRODUCTION: The purpose of this study is to examine short-term outcomes of patients undergoing bariatric surgery with concurrent paraesophageal hernia (PEH) repair versus bariatric surgery alone. PEHs are relatively common amongst obese patients. They must be repaired either before or concurrently with bariatric surgery. However, there remains debate on whether this is best done prior, in a separate operation, or at the time of bariatric surgery.
METHODS & PROCEDURES: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry was used to identify patients who had undergone bariatric surgery with concurrent PEH repair. Patients undergoing primary bariatric surgery at an accredited institution between 2015 and 2016 were included. Bariatric surgery procedures included laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG). A propensity-score matching algorithm, accounting for patient age, sex, body mass index (BMI) and comorbidities, was used to match these patients to a cohort of patients who underwent bariatric surgery alone. Overall 30-day incidence of major complications was the primary outcome. Secondary outcomes included mortality, length of operation, length of stay, readmission and reoperation.
RESULTS: The MBSAQIP database identified 222,320 bariatric procedures without PEH and 42,732 procedures with concurrent PEH repair (16.12% of the total). Baseline age, BMI, and comorbidities were significantly different between cohorts. With one-to-one propensity score matching, 42,379 pairs were selected. Background characteristics, including age, sex, preoperative BMI and preoperative comorbidities did not differ statistically between matched cohorts. There was no statistically significant difference in 30-day major complications (PEH 3.48% vs no PEH 3.36%, p=0.317) or mortality (PEH 0.06% vs no PEH 0.08%, p=0.189) after surgery. Reoperation within 30 days (PEH 1.24% vs no PEH 1.11%, p=0.08) were also similar. Rates of readmission were higher with concurrent PEH repair (3.99 vs 3.59%, p= 0.002) and length of stay was longer without PEH repair (1.74 vs 1.63 days, p<0.001). The cohort including PEH repair did have slightly longer operative times (87.09 vs. 81.19 minutes, p<0.001).
CONCLUSIONS: With a total of 42,732 concurrent PEH repair procedures, this is the largest retrospective study to date. Our analysis indicates that the incidence of major complications for bariatric surgery with concurrent PEH repair is similar to bariatric surgery alone. However, rates of readmission and operative time are higher with concurrent PEH repair. Overall, this study demonstrates the safety of concurrent bariatric surgery and PEH repair.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94779
Program Number: P170
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster
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