Concomitant hiatal hernia repair during bariatric surgery: does the reinforcement make the difference?

Concomitant hiatal hernia repair during bariatric surgery: does the reinforcement make the difference? Minerva Chir. 2020 Oct 02;: 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. METHODS: the prospective database of 1876 bariatric operations performed in a center of excellence between 2011-2019 was searched for concomitant HHR. Intraoperative measurement of the hiatal surface area (HSA) was performed routinely. RESULTS: A total of 250 patients undergone bariatric surgery and concomitant HHR (13%). Simple PC (group A, 151 patients) was performed during 130 LSG, 5 re-sleeves and 16 gastric bypasses; mean BMI 43.4 ± 5.8 kg/m2, HSA mean size 3.4 ± 2 cm2. Reinforced PC (group B) was performed in 99 cases: 62 primary LSG, 22 LGB and 15 revisions of LSG; mean BMI 44.6 ± 7.7 kg/m2, HSA mean size 6.7 ± 2 cm2. PC's failure, with intrathoracic migration (ITM) of the LSG was en...
Source: Minerva Chirurgica - Category: Surgery Tags: Minerva Chir Source Type: research

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This study reviews treatment recommendations and patient compliance at a multi-surgeon bariatric clinic.
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Abstract BACKGROUND: Abdominal wall hernias continue to be one of the most common general surgery pathologies. Patients with an elevated body mass index (BMI) are routinely counseled about weight loss before elective repair. However, a definitive BMI "cutoff" has not been established. Here, we report our experience with open retro-rectus hernia repair (ORRHR) with mesh in patients with a BMI over 40 kg/m2, and we attempt to determine if a BMI "cutoff" can be established. METHODS: Data from patients undergoing ORRHR with mesh at Geisinger Medical Center from January 1, 2014, to December 31,...
Source: The American Surgeon - Category: Surgery Authors: Tags: Am Surg Source Type: research
This study was a retrospective review of a prospectively maintained hernia registry from the 1st of February 2019 to 29th of February 2020.Results353 ventral hernia repair cases were recorded of which 47% were incisional hernias and the remainder were primary hernias. The median age was 54  years with even distribution of males and females. Half of the patients were obese with a median BMI of 31 kg/m2. The private sector performed 190 cases (54%) and the public sector 163 cases (46%). The public sector had more current smokers undergoing elective repairs, 28% vs 15%,p = 0.01 and performed more emerg...
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CONCLUSIONS: Obesity was a prevalent comorbidity in the patient population we reviewed. Given the role obesity plays in abdominal and hiatal hernia repair success rates, it should be considered that obesity is a significant contributor to chest wall herniation if rib fractures occur. With 66% chest wall repair failure, patient selection is critical in the success of surgical intervention. Perhaps additional patient optimization, especially weight loss, should be considered prior to surgery. PMID: 32927964 [PubMed - as supplied by publisher]
Source: The American Surgeon - Category: Surgery Authors: Tags: Am Surg Source Type: research
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Source: Obesity Surgery - Category: Surgery Source Type: research
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Hiatal hernias are often repaired concurrently with bariatric surgery to reduce risk of GERD-related complications.
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Roux-en-Y gastric bypass (RYGB) is an effective treatment for morbid obesity and gastroesophageal reflux disease (GERD) 1. Despite majority of patients with resolution of GERD after RYGB, some patients will continue to complain of significant, persistent reflux symptomatology or develop de novo symptoms despite aggressive medical management. It ’s true incidence is unknown and one study showed an improvement in GERD but not resolution in 22% of patients after RYGB with GERD2. Possible mechanisms may include primary lower esophageal sphincter incompetence, disruption of the angle of His or development of hiatal hernia...
Source: Surgery for Obesity and Related Diseases - Category: Surgery Authors: Tags: VIDEO CASE REPORT Source Type: research
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