Late-term hiatal hernia after gastric bypass: an emerging problem
Gastric bypasses were the most common bariatric surgery for many years, and long-term complications after gastric bypass are known to be relatively common. Symptomatic hiatal hernia (HH) with pouch migration is a less-known complication. However, when these are symptomatic, they require surgical repair.
Gastric bypasses were the most common bariatric surgery for many years, and long-term complications after gastric bypass are known to be relatively common. Symptomatic hiatal hernia (HH) with pouch migration is a less well-known complication. However, when these are symptomatic, they require surgical repair.
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.
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.
We present a case series of late term hiatal hernias after gastric bypass, and discuss the common presentation and treatment.
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
ConclusionsRYGB may increase the risk of CDI hospitalization when compared to VSG and VHR controls. This data suggest VSG may be a better bariatric choice when post-surgical CDI risk is a concern.
Morbidly obese patients are predisposed to developing ventral hernias. Although the optimal timing of ventral hernia repair (VHR) and bariatric surgery is unclear, concurrent management remains common. The aim of this study was to assess the incidence of wound site occurrence in the setting of VHR during bariatric surgery.