A510 Impact of Preoperative BMI, Hiatal Hernia Repair and Long-term %Excess Weight Loss Impact on GERD Symptoms after 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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Hiatal Hernia Repair during Laparoscopic Sleeve Gastrectomy: Systematic Review and Meta-analysis on Gastroesophageal Reflux Disease symptoms changes

Polish Journal of Surgery ◽

10.5604/01.3001.0014.9356 ◽

2021 ◽

Vol 93 (5) ◽

pp. 1-5

Author(s):

Piotr Małczak ◽

Magdalena Pisarska-Adamczyk ◽

Piotr Zarzycki ◽

Michał Wysocki ◽

Piotr Major

Keyword(s):

Systematic Review ◽

Sleeve Gastrectomy ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Hernia Repair ◽

Hiatal Hernia ◽

Reflux Disease ◽

De Novo ◽

Hiatal Hernia Repair ◽

Gerd Symptoms

Introduction Obesity is associated with a higher prevalence of various comorbidities including gastroesophageal reflux disease. It is yet still unclear whether LSG exacerbates or alleviates GERD symptoms. Available date in the literature on LSG influence on GERD are contradictory. Material and methods Systematic review of literature comparing GERD in sleeve gastrectomy versus sleeve gastrectomy with concomtitant hiatal repair. The review was conducted in January 2021 in accordance to PRISMA guidelines. Inclusion criteria involved reporting GERD and comparison of above mentioned techniques. Primary outcome of interest were alleviation of GERD and “de-novo” GERD symptoms. Secondary outcomes were operative time and morbidity. Results Initial search yielded 831 records. After the review and full-text screening 5 studies were included in the analysis. There were no differences in terms of GERD outcomes, p=0.74 for alleviation, p=0.77 for new symptoms. Concomitant hiatal hernia repair significantly prolongs sleeve gastrectomy by 38 mins. Conclusion There are no differences in GERD between hiatal hernia repair during sleeve gastrectomy in comparison to sleeve gastrectomy alone. More high-quality studies are required to fully evaluate this subject.

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Comment on: Sleeve gastrectomy with concomitant hiatal hernia repair in obese patients: long-term results on gastroesophageal reflux disease

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2020.05.027 ◽

2020 ◽

Vol 16 (9) ◽

pp. 1177-1178

Author(s):

Benjamin Clapp

Keyword(s):

Sleeve Gastrectomy ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Hernia Repair ◽

Hiatal Hernia ◽

Reflux Disease ◽

Long Term Results ◽

Hiatal Hernia Repair ◽

Obese Patients

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What is The Effect of Sleeve Gastrectomy in Patients with a BMI ≥ 50 kg/m2?

10.21203/rs.3.rs-388077/v1 ◽

2021 ◽

Author(s):

Alper Ozturk ◽

Yusuf Celik

Keyword(s):

Weight Loss ◽

Sleeve Gastrectomy ◽

Excess Weight Loss ◽

Treatment Method ◽

Hiatal Hernia Repair ◽

Total Weight Loss ◽

The Mean ◽

N 93 ◽

Long Term Studies

Abstract Background: To investigate the effect of Sleeve Gastrectomy (SG) in patient with a Body Mass Index (BMI)≥50 kg/m² groups on weight loss and comorbidities as the first and alone option. Methods: The prospectively maintained data obtained from patients with a BMI ≥ 50 who underwent SG between February, 2016 - February, 2020 were evaluated. Results: 138 patient with a BMI≥50 kg/m² underwent surgery. Average BMI: 56.36±7.661, age 37.41±12.33. Forty eight patients underwent cholecystectomy and/or hiatal hernia repair (HHR), as well. The percentage of excess weight loss (%EWL) values of patients in months 3, 6, 12 and 24 were 36.70%, 54.34%, 67.58%, 72.45%, 74.14% and the percentage of total weight loss (TWL%) values were 20.17%, 29.59%, 36.93%, 39.62%, 40.65%, respectively. The mean BMI values in month 0 and in the 3rd, 6th, 12th, 18th, 24th months were 56.36, 45.10, 39.76, 35.48, 33.96 and 33.42 respectively. The values measured in the month 0 and in the 3rd, 6th, 12th, 18th, 24th months were significantly different for EWL%, TWL% and BMI variables (p<0.001), but EWL% (p = 0.527), TWL% (p = 0.396) and BMI (p=0.657) were not found significantly different between the 18th and 24th months. When EWL% was accepted as ≥50, the success rate was found to be 93.55%(n=93) and 92%(n=50) in months 12 and 24, respectively. Conclusion: SG appears to be an effective and safe treatment method as the first option for weight loss and for treatment of concomitant disorders in patient with a BMI ≥ 50 kg/m² groups. Further long-term studies are needed to confirm these results.

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Nissen Fundoplication–Preserving Laparoscopic Sleeve Gastrectomy

The American Surgeon ◽

10.1177/000313481908500224 ◽

2019 ◽

Vol 85 (2) ◽

pp. 173-176 ◽

Cited By ~ 3

Author(s):

Craig R. Smith ◽

Jeffrey T. Gardner ◽

Lexie H. Vaughn ◽

Robert J. Kelly ◽

Oliver C. Whipple

Keyword(s):

Weight Loss ◽

Sleeve Gastrectomy ◽

Postoperative Complications ◽

Laparoscopic Sleeve Gastrectomy ◽

Excess Weight Loss ◽

Nissen Fundoplication ◽

Excess Weight ◽

Concomitant Treatment ◽

The Mean ◽

Gerd Symptoms

Gastroesophageal reflux disease (GERD) is significantly more prevalent in obese patients. Nissen fundoplication alleviates symptoms in those refractory to dietary changes and optimal medical management. The need for concomitant treatment of GERD and obesity is becoming more prevalent. The objective of this study was to determine whether Nissen-preserving laparoscopic sleeve gastrectomy (SG) is a safe and effective weight loss option for patients with pre-existing Nissen fundoplication. The study was conducted at the Hospital Corporation of America, Memorial Health, Savannah, Georgia, academic institution. We retrospectively reviewed five patients who underwent laparoscopic Nissen-preserving SG between 2011 and 2017. We compared pre- and postoperative subjective GERD symptoms, occurrence of any immediate postoperative complications, change in BMI, and excess weight loss. Of the five patients, four were female and one was male. The mean age was 50.6 years. The mean preoperative BMI was 44.8 ± 5.4, one-month postoperative BMI was 41.2 ± 6.1 (P < 0.001), and six-month postoperative BMI was 37.5 ± 8.1 (P < 0.009), with mean excess weight loss at six months of 33.9 ± 23 per cent. There were no immediate postoperative complications. Subjective GERD symptoms were unchanged in two patients and improved in the other three. We demonstrate the early feasibility of Nissen-preserving SG for surgical weight loss in patients with existing Nissen fundoplication. Although our results are early, we feel encouraged by mean excess weight loss to date and control of GERD symptoms.

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