Concomitant Hiatal Hernia Repair With Sleeve Gastrectomy: Impact on Gastroesophageal Reflux?

Abstract

Background: Hiatal hernia (HH), whenever encountered during sleeve gastrectomy (SG), needs to be addressed because of its strong association with gastroesophageal reflux disease (GERD). However, the mid-term to long-term effects of hiatal hernia repair (HHR) on GERD remain unclear. Methods: This was a cross-sectional observational analysis of patients who underwent SG + HHR and had completed at least 1 year of follow-up. The preoperative data were retrieved from a prospectively maintained database. Of the 590 patients who underwent SG, 63 patients (10.7%) with concomitant HHR were assessed for the use of proton pump inhibitors (PPIs) and symptoms of GERD using the GERD-Q questionnaire. Results: Of the 63 patients, 11 were lost to follow-up, and one underwent Roux-en-Y gastric bypass for HH recurrence and severe reflux. The remaining 51 patients were assessed at a mean follow-up of 3.7±2.0 years. Of these, 51% (26/51) patients had preoperative reflux symptoms. On follow-up, 69.2% (18/26) had complete resolution with significant improvement in their GERD-Q scores (9.8±3.1 to 6.5±2.1; P=0.001), while 76.2% (16/21) of patients were off the PPIs. The incidence of de novo GERD was found in 20% (5/25) of the patients. Conclusions: In patients of morbid obesity with HH, concomitant HHR with SG leads to improvement of the reflux symptoms in more than two-thirds of the patients, besides alleviating the use of PPIs.