A179 Concomitant Bariatric Surgery and Paraesophageal Hernia Repairs Using Bioabsorbable Matrix
Paraesophageal and sliding-type hiatal hernias are extremely common in patients who suffer from obesity. Concomitant hernia repairs at the time of bariatric surgery have been reported in as high as 20% of all bariatric surgeries. Bioabsorbable tissue matrices have been used to bolster and enhance sutured paraoesophageal hernia defects and reduce local recurrences. To date there exists no large volume study assess outcomes of hiatus hernias repaired at the time of concomitant bariatric surgery, particularly with respect to the use of bioabsorbable tissue matrix.
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 a case series of late term hiatal hernias after gastric bypass, and discuss the common presentation and treatment.
Post-bariatric, de-novo hiatal hernias are associated with a cluster of symptoms including Bloating (nausea/vomiting), Abdominal pain, Regurgitation, and Food intolerance or dysphagia (BARF). Patients with this cluster are at risk mis-diagnosis, malnutrition and maladaptive eating.
Paraesophageal hernias (PEH) are common among patients with obesity. Most patients with severe obesity and a PEH will have the PEH repaired at the time of bariatric surgery. However, it is unclear whether there is increased risk when repairing a PEH during bariatric surgery.
Paraesophageal hernias (PEH) are common among patients with obesity. Most patients with severe obesity and a PEH will have it repaired at the time of bariatric surgery. However, it is unclear whether there is increased risk for repairing a PEH during bariatric surgery.
AbstractBackgroundControversy exists regarding the clinical utility of routine preoperative upper gastrointestinal (GI) fluoroscopy in morbid obese patients undergoing laparoscopic sleeve gastrectomy (LSG). The aim of our study was to determine the efficacy of these studies in detecting hiatal hernias (HH).MethodsThe institution ’s prospectively maintained, IRB-approved database was retrospectively queried to identify all consecutive patients who underwent LSG between 2011 and 2017. All patients underwent routine preoperative upper GI fluoroscopy. Reports from all imaging studies were retrospectively reviewed and com...
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.
Background: As bariatric surgery becomes increasingly prevalent, new questions arise regarding management of coexisting surgical issues in this population. No clear consensus exists regarding treatment of patients undergoing bariatric surgery with concomitant or recurrent hernias. We aim to review the available literature in order to provide recommendations regarding hernia repair in these patients.
Patients with obesity have a higher incidence of ventral hernias and are at greater risk of developing complications after hernia repair [1,2]. These complications include a higher risk of recurrence, wound infection, wound breakdown, and venous thromboembolic episodes. The elevated intra-abdominal pressure, increased abdominal circumference, and visceral fat may play a role, as might the association of obesity with type 2 diabetes.
Patients with obesity have a higher incidence of ventral hernias and are at greater risk of developing complications after hernia repair (1,2). These include a higher risk of recurrence, wound infection, wound breakdown and venous thromboembolic episodes. The elevated intra-abdominal pressure, increased abdominal circumference and visceral fat may play a role as does the association of obesity with type 2 diabetes.