Management of Paraesophageal Hernia in the Morbidly Obese Patient
Gastroesophageal reflux disease (GERD) is common in the morbidly obese population, and hiatal hernias are encountered in 20% to 52% of patients. Primary surgical repair of hiatal hernias, in particular the paraesophageal type, is associated with a higher recurrence rate in obese patients. Concomitant weight loss surgery may be advisable. Combined sleeve gastrectomy and paraesophageal hiatal hernia repair is feasible but can induce or worsen preexisting GERD. A Roux-en-Y gastric bypass offers advantages of more pronounced excess weight loss and better symptom control, albeit with a potentially higher rate of morbidity compared with paraesophageal hernia repair alone or sleeve gastrectomy.
(Medical College of Georgia at Augusta University) Eight months of daily, afterschool physical activity in previously inactive 8- to 11-year-olds with obesity and overweight improved key measures of their cardiovascular health like good cholesterol levels, aerobic fitness and percent body fat, but didn't improve others like arterial stiffness, an early indicator of cardiovascular risk, Medical College of Georgia investigators report.
Journal Name: Journal of Pediatric Endocrinology and Metabolism Issue: Ahead of print
This study assessed 1) fasting and postprandial insulin and glucose before and after 2 weeks of HIIT in healthy adolescent boys, and 2) the relationship between pre intervention health outcomes and the effects of the HIIT intervention.MethodsSeven healthy boys (age:14.3 ± 0.3 y, BMI: 21.6 ± 2.6, 3 participants classified as overweight) completed 6 sessions of HIIT over 2 weeks. Insulin resistance (IR) and blood glucose and insulin responses to a Mixed Meal Tolerance Test (MMTT) were assessed before (PRE), 20 h and 70 h after (POST) the final HIIT ses sion.ResultsTwo ...
ConclusionIn this study, fewer than 20% of adolescents with severe obesity lost> 50% of their excess weight following LAGB. Nearly 50% of patients required additional surgery. With reports of success following sleeve gastrectomy and gastric bypass, we believe that LAGB is not a preferred choice to treat adolescents with obesity.
Both hiatal hernias (HH) and morbid obesity significantly contribute to gastroesophageal reflux disease which increases the risk for esophagitis and esophageal cancer. Therefore, concomitant HH repair is recommended during bariatric surgery procedures. Unfortunately, recurrence of HH following repair is not uncommon and the optimal surgical technique has yet to be established.
Obesity is known to be an independent risk factor for gastroesophageal reflux disease (GERD), as well as a contributing cause of hiatal hernias (HH). Laparoscopic sleeve gastrectomy (LSG) is considered a viable surgical option for weight loss; however, some surgeons suggest avoiding this procedure in patients with preexisting gastroesophageal reflux disease symptoms (GERDS) because of concern for worsening of these symptoms. The effect of LSG on GERDS is unclear, with studies reporting conflicting results.
Obesity is a major risk factor for hiatal hernias. High recurrence rates are reported following Nissen fundoplication in morbidly obese patients. Following a failed fundoplication, an acid diverting procedure (i.e. RYGB) is highly successful in reflux remission and weight loss.
We report mid-term results from a larger series with combining laparoscopic giant PEH repair with sleeve gastrectomy (SG). Methods We reviewed all combined cases of PEH repairs with SG done at a single institution from 2008 to 2013. The surgical technique was standardized and absorbable bio-prosthetic buttress crural closure reinforcement was used selectively. Yearly upper gastrointestinal radiographic (UGI) studies and postoperative Gastroesophageal Reflux Disease Health-Related Quality of Life questionnaires were completed. 33 patients were enrolled; 18 patients (55 %) com...