A623 Laparoscopic Hiatal Hernia Repair with Mesh in a Sleeve Patient for Recurrent Reflux
74-year-old female with a history of sleeve gastrectomy with hiatal hernia repair 5 years ago presented complaining of severe reflux. Patient had successful weight loss but developed recurrence of her severe reflux and hiatal hernia. She underwent hiatal hernia repair with anterior fundoplication 6 months ago to no avail.
Authors: Boru CE, Termine P, Antypas P, Iossa A, Ciccioriccio MC, De Angelis F, Micalizzi A, Silecchia G Abstract BACKGROUND: Hiatal hernia repair (HHR) is still controversial during bariatric procedures, especially in case of laparoscopic sleeve gastrectomy (LSG). AIMS: to report the long-term results of concomitant HHR, evaluating the safety and efficacy of posterior cruroplasty (PC), simple or reinforced with biosynthetic, absorbable Bio-A® mesh (Gore, USA). Primary endpoint: PC's failure, defined as symptomatic HH recurrence, nonresponding to medical treatment and requiring revisional surgery. METHO...
ConclusionsIn this study, staged mesh repair of complex abdominal wall hernias after bariatric surgery in morbidly obese patients was associated with acceptable morbidity and no hernia recurrences at approximately 1.5 year follow-up.
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.
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).
Discussions are present on the concerns of increased leak rates due to crural dissection. We investigated the effect of simultaneous hiatal hernia repair in LSG(HR-LSG) on perioperative outcomes.
We present a query of national bariatric surgery data investigating the efficacy of concurrent laparoscopic sleeve gastrectomy and paraesophageal hiatal hernia repair (LSGPEHR) as compared to laparoscopic sleeve gastrectomy (LSG).
This study describes changes in GERD symptoms in patients undergoing LSG and HHR.
Gastric herniation following laparoscopic sleeve gastrectomy is a surgical complication presented in up to 37% of cases in some studies. The intrathoracic migration of the stomachcan happen as early as 1 month after surgery.
38-year-old female with no symptomatic reflux who underwent a sleeve gastrectomy for morbid obesity. At the time of surgery, she was found to have an approximately 5 cm hiatal hernia, which was repaired posteriorly. Post-operatively, she developed significant nausea and vomiting. Upper GI study and CT scan demonstrated a failure of the hiatal hernia repair with a significant portion of the stomach in the chest. She was taken back to the operating room for repair.
We present a novel case of managing GERD with laparoscopic MSA and hiatal hernia repair after LSG.