A. Wang1, M. Turner1, S. Sprinkle1, A. D. Guerron1, D. Portenier1, C. Park1, R. Sudan1, J. Yoo1, K. Seymour1 1Duke University Medical Center,Surgery,Durham, NC, USA
Introduction:
Hiatal hernias are found in 40% of morbidly obese patients. For bariatric surgery candidates with hiatal hernias, the role of concurrent hiatal hernia repair (HHR) during laparoscopic sleeve gastrectomy (LSG) remains uncertain. We hypothesize that concomitant HHR during LSG is a safe procedure.
Methods:
After IRB approval, retrospective review from August 2011 to December 2013 at a single institution resulted in 410 patients who underwent LSG. Isolated LSG was performed on 221 patients and LSG with HHR was performed on 188 patients. Six surgeons performed all cases with no open conversions. Excess BMI loss was calculated as percent decrease in BMI compared to ideal BMI 25. Continuous variables were compared with t-tests and categorical variables were compared with Wilcoxon rank-sum or Fisher’s exact test.
Results:
Baseline patient characteristic did not significantly differ between groups (Table). Intraoperative assessment revealed 105 patients with mild to moderate hiatal hernias, 52 with moderate sized, 7 with large sized, and 7 with paraesophageal. Intraoperative HHR used anterior approach in 9% of patients, anterior and posterior approach in 7%, and posterior approach in the remainder. Reinforcement with mesh was used in 47% of patients. Operative time was significantly longer in the HHR group (91 vs 76 min, p< 0.0001, CI: 9.9-19.4). When a single surgeon routinely performs HHR (n=147), however, there was no significant difference in operative time compared to sleeve alone (n=31) (88.9 vs 82.2 min, p=0.16, CI -2.7-16.4). Between groups, there was no difference in estimated blood loss (22.7 vs 20.0 ml, p-0.23, CI -1.8-7.3) or length of stay (1.6 vs 1.8 days, p=0.07, CI -0.4-0.01). Neither group experienced a 30-day mortality, reoperation, pulmonary embolism, or leak and both groups had similar rates of 30-day readmission (n=4). Sleeve with HHR resulted in increased excess BMII loss at 3 months (40.1% vs 36.0%, p=0.003, CI 1.3-6.9) and 6 months (52.5% vs 45.9%, p=0.01, CI 1.6-11.6).
Conclusion:
LSG with concurrent HHR is safe and does not result in increased short-term mortality or morbidity. When routinely performed, LSG with HHR does not result in increased operative time. In our cohort, LSG with HHR also resulted in increased weight loss, possibly due to improved mobilization and resection of the gastric fundus.
