Initial Experience with Laparoscopic Crural Closure in the Management of Hiatal Hernia in Obese Patients Undergoing Sleeve Gastrectomy

Abstract Background The effect of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) is controversial. Although concomitant hiatal hernia repair (HHR) at the time of LSG is common and advocated by many, there are few data on the outcomes of GERD symptoms in these patients. The aim of this study was to evaluate the effect of concomitant HHR on GERD symptoms in morbidly obese patients undergoing LSG. Aim of the Work To analyse the impact of hiatal hernia repair (HHR) on gastro-oesophageal reflux disease (GERD) in morbidly obese patients with hiatus hernia undergoing laparoscopic sleeve gastrectomy (LSG). Patients and Methods This is a retrospective cohart study. We collected the data of Patients who underwent lap sleeve gastrectomy with cruroplsty in the same operation in the period between July 2018 and July 2019. Results Before surgery, symptomatic GERD was present in 14 patients (70%), and HH was diagnosed In 20 patients (100%), HH was diagnosed pre-operatively. The mean follow-up was 6 months. GERD remission occurred in 18 patients (90%). In the remaining 2 patients, antireflux medications were diminished, with complete control of symptoms. HH recurrences developed in 1 patient (10%). "De novo" GERD symptoms developed in 22.9% of the patients undergoing SG alone compared with 0% of patients undergoing SG plus HHR. Conclusion SG with HHR is feasible and safe, providing good management of GERD in obese patients with reflux symptoms. Small hiatal defects could be underdiagnosed at preoperative endoscopy and/or upper gastrointestinal contrast study. Thus, a careful examination of the crura is always recommended intraoperatively.

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Management of the Crura During Laparoscopic Sleeve Gastrectomy

The American Surgeon ◽

10.1177/00031348211050285 ◽

2021 ◽

pp. 000313482110502

Author(s):

Edward C. Tobin ◽

Chelsea Knotts ◽

Jonathon Tsai ◽

Jeffrey Austin ◽

Stephanie Thompson ◽

...

Keyword(s):

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Hiatal Hernia ◽

Chart Review ◽

Mesh Reinforcement ◽

Crural Closure ◽

Procedural Complications ◽

Secondary Endpoints ◽

Period Data ◽

Suture Closure

Despite the increasing number of bariatric procedures being performed, the optimal strategy for managing the crura during laparoscopic sleeve gastrectomy (LSG) remains controversial. Options include no closure, primary suture closure, and suture closure with mesh reinforcement. We sought to investigate outcomes associated with each technique and determine if any approach proved to be superior. Methods This is a retrospective cohort study that evaluated patients undergoing LSG performed by a single surgeon in a 7-year period. Data were collected via chart review. The primary endpoint was hiatal hernia presence at 5 years post-operatively. Secondary endpoints included post-procedural complications (nausea, vomiting, dysphagia, or reflux) at 30 days post-operatively. Results A total of 361 patients were included in the analysis: 154 without crural closure, 164 primary crural closure, and 43 primary crural closure with mesh reinforcement. Rates of hiatal hernia occurrence at 5 years were 9.7% (no closure), 14.0% (primary closure), and 16.3% (closure with mesh reinforcement), respectively, and did not differ significantly among the 3 cohorts (P = .37). Overall rates of 30-day complications were 11.5%, 21.5%, and 28.6%, respectively ( P = .015). Conclusion Rates of hiatal hernia after sleeve gastrectomy do not differ, regardless of management of the crura. In addition, and perhaps more significantly, avoidance of crural closure was associated with fewer 30-day complications. In fact, the highest rate of 30-day complications was seen in the group that received closure with mesh reinforcement. These data suggest that crural closure during LSG should be avoided. Further prospective study of these findings is warranted.

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The effect of laparoscopic sleeve gastrectomy with or without hiatal hernia repair on gastroesophageal reflux disease in obese patients

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2013.09.006 ◽

2014 ◽

Vol 10 (2) ◽

pp. 250-255 ◽

Cited By ~ 64

Author(s):

Antonella Santonicola ◽

Luigi Angrisani ◽

Pierpaolo Cutolo ◽

Giampaolo Formisano ◽

Paola Iovino

Keyword(s):

Sleeve Gastrectomy ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Hernia Repair ◽

Laparoscopic Sleeve Gastrectomy ◽

Hiatal Hernia ◽

Reflux Disease ◽

Hiatal Hernia Repair ◽

Obese Patients

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SLEEVE GASTRECTOMY AND FUNDOPLICATION AS A SINGLE PROCEDURE IN PATIENTS WITH OBESITY AND GASTROESOPHAGEAL REFLUX

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-6720201700030012 ◽

2017 ◽

Vol 30 (3) ◽

pp. 216-221 ◽

Cited By ~ 10

Author(s):

Juan Pablo LASNIBAT ◽

Italo BRAGHETTO ◽

Luis GUTIERREZ ◽

Felipe SANCHEZ

Keyword(s):

Sleeve Gastrectomy ◽

Gastroesophageal Reflux ◽

Hiatal Hernia ◽

Revision Surgery ◽

Ph Monitoring ◽

Obese Patients ◽

Group A ◽

Clinical Records

ABSTRACT Background: Bariatric surgery in Chile has seen an exponential increase in recent years, especially in sleeve gastrectomy. Its use is currently discussed in patients suffering from gastroesophageal reflux disease. Different options have been considered for the management of these patients but up to now laparoscopic Roux-en-Y gastric bypass seems to be the best option. Sleeve gastrectomy plus concomitant fundoplication or hiatal hernia repair also has been suggested in patients having reflux or small hiatal hernia. Aim: To present a cohort of obese patients with gatroesophageal reflux undergoing this procedure, which seeks to provide the benefits of both laparoscopic gastric sleeve (LSG) and antireflux surgery focused on the evaluation of presence of reflux and BMI after surgery, and to compare the result observed in this cohort with a previous group of obese patients without reflux submitted to sleeve gastrectomy alone. Methods: Retrospective case series in 15 patients who underwent this surgery between the years 2003 and 2012. Clinical records were analyzed and values of 24 hr pH monitoring, esophageal manometry and clinical outcome were recorded. Results were compared to a previous series of patients who underwent LSG. No statistical analyses were made. Results: Group A consisted of 15 patients submitted to LSG plus fundoplication. 93% (n=14) were female. Mean age was 46.2 years. Mean preoperative body mass index (BMI) was 33.9. All patients had altered pH monitoring and manometry preoperatively. There was one minor complication corresponding to a seroma. There was no perioperative mortality. Group B consisted of 23 obese patients who underwent LSG. These patients developed de novo reflux, hypotensive LES and esophagitis after the surgery. Group A patients showed improvement in esophageal pH monitoring and manometry at three months. During long-term follow-up, six underwent revision surgery, four for weight regain, one regained weight associated with symptomatic reflux, and one underwent re-intervention for reflux. Conclusions: Good results are observed in the short-term follow up in both reflux resolution and weight loss. Nevertheless, results at long term are discouraging, with 53.3% of the patients requiring revision surgery during follow-up.

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Acute paraoesophageal hiatal hernia following laparoscopic sleeve gastrectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20205378 ◽

2020 ◽

Vol 7 (12) ◽

pp. 4177

Author(s):

Omar M. Alobaid ◽

Abdullah S. Alzahrani ◽

Bander I. Ali

Keyword(s):

Bariatric Surgery ◽

Morbid Obesity ◽

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Hiatal Hernia ◽

Independent Risk Factor ◽

Morbidly Obese ◽

Obese Patients ◽

Significant Weight Loss ◽

Operative Endoscopy

Anti-obesity surgery is the most effective therapy available for significant weight loss in patients with morbid obesity. Obesity in consider a major independent risk factor for Hiatal hernia (HH) and it is present in about 37%-50% of morbidly obese patients undergoing bariatric surgery.1,2,3 It might be overlooked or under looked especially if the patient was asymptomatic and no pre-operative endoscopy or radiological workup. Denovo closure of the hiatal defect in case of an intraoperative finding of HH strongly recommended preventing such acute postoperative complications. Herein we report a rare and acute post laparoscopic sleeve gastrectomy with gastric herniation were uneventfully diagnosed and interfered early to prevent a catastrophic outcome.

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