Allison C Estep, MD1, Christopher J You, MD2. 1MedStar Union Memorial Hospital, 2MedStar Franklin Square Medical Center
Background: The effect of sleeve gastrectomy on gastroesophageal reflux (GERD) remains controversial. It is currently common practice to perform a hiatal hernia repair (HHR) at the time of the sleeve gastrectomy, however, there are few data on the outcomes of GERD symptoms in these patients. The aim of this study was to evaluate the effect of performing an esophagopexy hiatal hernia repair on GERD symptoms in morbidly obese patients undergoing robotic sleeve gastrectomy (RSG).
Methods: A single institution, single surgeon, prospectively maintained database was used to identify patients who underwent RSG and concomitant esophagopexy for hiatal hernia repair from November 2015 to July 2017. Patient characteristics, operative details and postoperative outcomes were analyzed. Primary endpoint was subjective GERD symptoms and recurrence of hiatal hernia.
Results: Thirty-seven patients were identified meeting the inclusion criteria (RSG + HHR + esophagopexy) with a mean follow-up of 28.7 weeks ± 21.1 weeks. This patient cohort was 86.5% female with a mean age of the patients being 47.0 ± 9.5 years. Mean preoperative BMI was 40.2 ± 6.0 kg/m2. Preoperative upper gastrointestinal contrast series was performed in 84.0% of the patients with the study showing a hiatal hernia in 71.0% of these patients. Preoperative esophagogastroduodenoscopy (EGD) was performed in 94.5% of the patients with the study showing a hiatal hernia in 56.8% of the patients. Preoperatively, 29.7% of patients had a documented diagnosis of GERD. After RSG with esophagopexy, 64.0% of symptomatic patients had resolution of their GERD symptoms while 36.4% remained symptomatic following the procedure. New onset GERD was seen in 10.8% of patients who did not have a documented diagnosis of GERD preoperatively. None of the patients experienced recurrence of their hiatal hernia.
Conclusion: This study showed that RSG with concomitant esophagopexy hiatal hernia repair improved GERD symptoms in over half of symptomatic patients. However, 10.8% of asymptomatic patients developed new onset GERD symptoms after undergoing the esophagopexy hiatal hernia repair. The resolution of GERD symptoms and new onset GERD rates are similar to the present rates in the literature for patients undergoing sleeve gastrectomy. This suggests that the esophagopexy does not affect GERD, but may impact recurrence rate of the hiatal hernia. Long term follow up of these patients is needed to demonstrate this theory.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88293
Program Number: P623
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster