A570 Combined Magnetic Sphincter Augmentation and Hiatal Hernia Repair for Treatment of Refractory GERD after Sleeve Gastrectomy
We present a novel case of managing GERD with laparoscopic MSA and hiatal hernia repair after LSG.
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.
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.
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.
In this video presentation we present a case of food intolerance after sleeve gastrectomy. The patient is a 68-year-old female with a BMI of 35.8kg/m2 who underwent a laparoscopic sleeve gastrectomy and hiatal hernia repair at an outside hospital. Soon after her initial procedure she developed progressive dysphagia, vomiting and chest discomfort. She was seen by a gastroenterologist. Manometry was inconclusive. The patient underwent seven pneumatic balloon dilatations of a presumed esophageal stricture without durable symptomatic relief before she was referred to surgery.
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.