A626 Hiatal hernia repair 14 years after gastric bypass with implantation of bioabsorbable mesh
Gastric bypasses (GB) can have late complications. One of these complications is hiatal hernia with pouch migration into the mediastinum. This can cause dysphagia, reflux and even aspiration. Bariatric surgeons need to be aware of this problem, how to diagnose it, and how to treat it. This video highlights the case of a patient who underwent a laparoscopic GB in 2004. She maintained about a 45 kg weight loss but over the last 2 years had developed progressively worse symptoms of dysphagia and reflux.
Morbid obesity is associated with an increased rate of hiatal and paraesophageal hernias (PEH). Concomitant repair at the time of Roux-En-Y gastric bypass is technically feasible, safe, and lowers recurrence rates; however, the ideal operative management remains controversial. The use of reinforcing mesh may further lower recurrence rates in the bariatric patient population. The patient is a 49 year-old female with a history of morbid obesity (BMI 42) and long-standing reflux with dysphagia. Preoperative endoscopy was notable for esophagitis and a moderate-sized PEH.
We present the first case of bariatric surgery in a patient with Ehlers-Danlos syndrome and outline management challenges in the context of the relevant literature. A 56-year-old man with type IV Ehlers-Danlos syndrome and a body mass index of 41.8 kg/m2 was referred to the bariatric centre of the Churchill Hospital, Oxford, for consideration of surgery for morbid obesity. His comorbidity included type 2 diabetes, hypertension, dyslipidaemia and obstructive sleep apnoea. He underwent a laparoscopic Roux-en-Y gastric bypass. His initial recovery was uneventful and he was discharged on the first postoperative day. Six weeks ...
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
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, intrathoracic sleeve migration and weight regain are commonly encountered in high volume bariatric centers. In our center we developed an algorithm for managing GERD following LSG that include aggresive dietary and lifestyle modifications, medications, STRETTA procedure and conversion to Roux en Y Gastric Bypass (RYGB) in patients with refractory GERD.
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]
The presence of a ventral hernia (POVH) presents a challenge during laparoscopic bariatric surgery and particularly during Roux-en-Y gastric bypass (LRYGB). The incidence of ventral hernias during laparoscopic bariatric surgery (BS) is reported to be around 5% with no consensus regarding optimal treatment. The extent of the fascial defect warrants consideration of either primary repair, synthetic or biologic mesh repair or delayed repair. Our study aim was to evaluate the outcomes of laparoscopic primary sutured repair of POVH in patients with a single abdominal wall fascial defect undergoing bariatric surgery.
As the number of patients increase who have previously undergone a laparoscopic Roux-en-Y Gastric Bypass (LRYGB) for morbid obesity, so does the amount of late complications associated with this procedure. The presence of GERD after bypass surgery is a very challenging disease process for the bariatric surgeon. Although the LRYGB is the procedure of choice for obese patients with severe reflux, where do we go if the patient develops reflux after the LRYGB. Some have advocated performing a Toupet or a Dor-like wrap using the remnant stomach with little evidence that it works.