Concurrent bariatric surgery and paraesophageal hernia repair: Comparison of sleeve gastrectomy and roux-en-y gastric bypass
Paraesophageal hernia (PEH) is a common condition that bariatric surgeons encounter. Expert opinion is split on whether bariatric surgery and PEH repair should be completed concurrently or sequentially. We hypothesized that concurrent bariatric surgery and PEH repair is safe.
ConclusionSynchronous VHR and BS in a bariatric unit is feasible with low recurrence rate. Laparoscopic VHR has lower complication rates than open, apart from seroma formation. Patients with diabetes have higher risk of infection.
This study aimed to assess practice patterns regarding concomitant HH repair (HHR) during laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). The incidence of concomitant HHR with LSG or LRYGB was analyzed using the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. One hundred thirty thousand, seven hundred seventy-two patients underwent RYGB (30.5%) and LSG (69.5%). Concomitant HHR was more common, despite less GERD, in SG patients compared to RYGB (21.0% vs 10.8%,p
ConclusionsRYGB may increase the risk of CDI hospitalization when compared to VSG and VHR controls. This data suggest VSG may be a better bariatric choice when post-surgical CDI risk is a concern.
Morbidly obese patients are predisposed to developing ventral hernias. Although the optimal timing of ventral hernia repair (VHR) and bariatric surgery is unclear, concurrent management remains common. The aim of this study was to assess the incidence of wound site occurrence in the setting of VHR during bariatric surgery.
This study aims to assess differences in practice patterns regarding concomitant HH repair during laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB).
Laparoscopic Sleeve Gastrectomy (LSG) is now the most commonly performed procedure in the US according to the most recent ASMBS estimates with excellent short and long term outcomes. However, long term complications following LSG, including refractory GERD, weight gain and intrathoracic sleeve migration are commonly encountered in high volume bariatric centers. Intra-thoracic sleeve migration can result in gastric strangulation and should be repaired immediately. In our center we have developed an aggressive approach in identifying and repairing hiatal ernias intraoperatively in combination with sleeve gastrect...
In conclusion, the recent publication of pH monitoring data and the new insights in the association between sleeve morphology and GERD control have led to a wider acceptance of LSG as bariatric procedure also in obese patients with GERD, as recently stated in the 5(th) International Consensus Conference on sleeve gastrectomy. PMID: 28428706 [PubMed - in process]
CONCLUSION: Small HH are over-diagnosed with EGD, as most do not require repair. However, moderate and large HH are accurately detected. PMID: 27639984 [PubMed - as supplied by publisher]
Conclusion A number of techniques can be used to mitigate the severity of reflux, either by maintaining the normal anatomic structures that limit reflux or by supplementing these structures with a plication or gastroplasty. Individuals with existing severe reflux should not be considered for a sleeve gastrectomy. New techniques that incorporate plication at the time of the index sleeve gastrectomy show some improvement, but these are in small series that will need to be further evaluated. The only proven method of treating intractable reflux after sleeve gastrectomy is conversion to a Roux-en-Y gastric bypass.