Concurrent Magnetic Sphincter Augmentation and Hiatal Hernia Repair for Refractory GERD Following Laparoscopic Sleeve Gastrectomy
Gastroesophageal reflux disease (GERD) has a reported incidence of between 10 to 20% in western populations with an even higher incidence in populations with obesity (1). The vast majority of patients are managed medically with surgical intervention undertaken in those with recalcitrant GERD. Populations with obesity and recalcitrant GERD who are interested in weight loss surgery have historically undergone Laparoscopic Roux En Y Gastric Bypass (LRYGB). De Goot et al in their 2009 meta-analysis demonstrated improvement in GERD in people with obesity following LRYGB(2).
Gastroesophageal reflux disease (GERD) has a reported incidence of between 10% and 20% in Western populations with an even higher incidence in populations with obesity . The vast majority of patients are managed medically with surgical intervention undertaken in those with recalcitrant GERD. Populations with obesity and recalcitrant GERD who are interested in weight loss surgery have historically undergone laparoscopic Roux-en-Y gastric bypass (LRYGB). De Goot et al. , in their 2009 meta-analysis, demonstrated improvement in GERD in people with obesity after LRYGB.
Hiatal hernia (HH) repair during laparoscopic sleeve gastrectomy (LSG) has been advocated to reduce postoperative gastroesophageal reflux disease (GERD) and/or intrathoracic migration (ITM) incidence. Previous,mid-term Results of a prospective, comparative study evaluating posterior cruroplasty concomitant with LSG (group A 48 patients with simple vs. group B 48 reinforced with bioabsorbable mesh) confirmed the safety and effectiveness of simultaneous procedures. Present aim: to report the 60 months follow-up update, evaluating GERD, esophageal lesions ’ incidence and HH’s recurrence.
This study describes changes in GERD symptoms in patients undergoing LSG and HHR.
The sleeve gastrectomy (SG) can be associated with postoperative gastroesophageal reflux (GERD) and when a hiatal hernia is present, it should be fixed. Earlier studies have shown that 20% of SG have a concomitant hiatal hernia repair (HHR) in a large clinical database (MBSAQIP). Administrative databases can also be used to examine this practice.
Sleeve Gastrectomy alters the normal stomach anatomy resulting in a significant incidence of hiatal hernia and gastroesophageal reflux disease. Although many patients remain asymptomatic, many complain of severe reflux symptoms not responsive to medical management. To describe the diagnosis and treatment of hiatus hernia after sleeve gastrectomy with conversion to Omega Loop Bypass and using fixation suture technique.
Sleeve gastrectomy (SG) patients often present with gastroesophageal reflux (GERD) symptoms postoperatively. Our aim was to evaluate factors that impact GERD recidivism or de novo after SG.
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 compa...
Day-case surgery (DCS) is a hot topic in gastrointestinal surgery. DCS was primarily validated for inguinal hernia repair, cholecystectomy  and the treatment of gastroesophageal reflux disease [2, 3]. New indications for DCS in the field of gastrointestinal surgery have been recently described, such as laparoscopic sleeve gastrectomy (SG) , ileostomy closure , colectomy  and liver resection .
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
Background: We are presenting a 35 year old patient with morbid obesity as well as symptoms of severe gastroesophageal reflux disease who, with preoperative imaging, was diagnosed with a large paraesophageal hernia. He underwent laparoscopic repair of the hernia as well as gastric bypass and was found at the time of surgery to have a large primary diaphragmatic hernia instead of a paraesophageal hernia. The defect did not appear to be either a Morgagni or Bochdalek hernia as it was centrally located in the diaphragm, just lateral to the left crus.