A160 Gastroesophageal reflux disease outcomes in patients undergoing laparoscopic sleeve gastrectomy and concurrent hiatal hernia repair
This study describes changes in GERD symptoms in patients undergoing LSG and HHR.
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).
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
Laparoscopic sleeve gastrectomy (LSG) is shown to be effective in achieving weight loss and improving related co-morbidities in patients who suffer from morbid obesity. Despite this, there is ongoing controversy regarding the potential of worsening and de novo gastrointestinal reflux disease (GERD) postoperatively. Current standard of care for worsening or new onset GERD status-post LSG indicates revision to laparoscopic roux-en-y gastric bypass (RYGB) in those patients not responsive to medical therapy.
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).
The patient is a 41 year old woman presenting with severe left shoulder pain, reflux symptoms, and weight regain after Primary Obesity Surgery Endolumenal (POSE). This video details a complex revision of the POSE procedure to a laparoscopic sleeve gastrectomy. Technical skills demonstrated in the video include dissection of the plicated and densely adherent greater curvature of the stomach, mobilization of the gastric fundus from the spleen with careful vascular control of splenic vessels, freeing endolumenal sutures to the stomach and spleen, hiatal hernia repair, elevation and resection of the phrenoesophageal fat pad to...
ConclusionsLaparoscopic HH repair offers a safe and feasible approach in the management of persistent GERD after LSG in well-selected bariatric patients. Larger prospective studies are warranted to investigate the effectiveness of HH repair in this population as 22% of our patients did not demonstrate postoperative symptomatic improvement.
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]
Conclusion: In morbidly obese patients with HH with or without GERD undergoing LSG, repair of the hiatus hernia helps in amelioration of GERD and prevents any new onset GER. Thus, the presence of HH should not be considered as a contraindication for LSG.