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Surgical Endoscopy
Published in: Surgical Endoscopy 5/2015

01-05-2015

Combining laparoscopic giant paraesophageal hernia repair with sleeve gastrectomy in obese patients

Authors: Ankit D. Patel, Edward Lin, Nathaniel W. Lytle, Juan P. Toro, Jahnavi Srinivasan, Arvinpal Singh, John F. Sweeney, S. Scott Davis Jr.

Published in: Surgical Endoscopy | Issue 5/2015

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Abstract

Background

Surgical treatment for giant paraesophageal hernias (PEH) in morbidly obese patients (BMI > 35) continues to be a difficult problem. Prior studies have demonstrated recurrence rates of up to 40 % with higher rates in morbidly obese patients. Reports have shown success combining repair with a bariatric procedure to decrease recurrence rates while achieving weight loss. We report mid-term results from a larger series with combining laparoscopic giant PEH repair with sleeve gastrectomy (SG).

Methods

We reviewed all combined cases of PEH repairs with SG done at a single institution from 2008 to 2013. The surgical technique was standardized and absorbable bio-prosthetic buttress crural closure reinforcement was used selectively. Yearly upper gastrointestinal radiographic (UGI) studies and postoperative Gastroesophageal Reflux Disease Health-Related Quality of Life questionnaires were completed. 33 patients were enrolled; 18 patients (55 %) completed the study

Results

No 30-day morbidity or mortality occurred. 16 patients were female; the average age was 55.3 ± 11.4 years (30–72) with follow-up from surgery of 19.9 ± 16.7 months (6–66). The average weight loss was 23.5 ± 12.7 kg (8–57); excess body weight loss was 46 ± 25.8 % (18–112). Based on the UGIs, 9/18 (50 %) had no evidence of hernia recurrence, while 6/18 (33 %) demonstrated a small (<2 cm) recurrence. 3/18 (17 %) patients had evidence of moderate recurrence (3–5 cm). Postoperative GERD-HRQL scores revealed an average score of 10 ± 7 (2–26). All patients reported being “satisfied” with their operation and weight loss and also had a significant improvement in foregut symptoms. No patient has required surgical revision and residual symptoms responded to conservative management.

Conclusions

PEH in morbidly obese patients remain a complex surgical problem. Our case series shows that combination with SG may decrease recurrence rates but more importantly leads to lower rates of reoperation for symptomatic recurrence. Patients also garner the added medical benefits of weight loss.
Literature
1.
2.
Ozdemir IA, Burke WA, Ikins PM (1973) Paraesophageal hernia. A life-threatening disease. Ann Thorac Surg 16(6):547–554CrossRefPubMed
3.
DeMeester SR (2013) Laparoscopic paraesophageal hernia repair: critical steps and adjunct techniques to minimize recurrence. Surg Laparosc Endosc Percutan Tech 23(5):429–435CrossRefPubMed
4.
Hashemi M et al (2000) Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate. J Am Coll Surg 190(5):553–560CrossRefPubMed
5.
Mattar SG et al (2002) Long-term outcome of laparoscopic repair of paraesophageal hernia. Surg Endosc 16(5):745–749CrossRefPubMed
6.
Khaitan L et al (2002) Laparoscopic paraesophageal hernia repair has an acceptable recurrence rate. Am Surg 68(6):546–551PubMed
7.
Davis SS Jr (2008) Current controversies in paraesophageal hernia repair. Surg Clin North Am 88(5):959–978CrossRefPubMed
8.
Gantert WA et al (1998) Laparoscopic repair of paraesophageal hiatal hernias. J Am Coll Surg 186(4):428–432CrossRefPubMed
9.
10.
Dahlberg PS et al (2001) Laparoscopic repair of large paraesophageal hiatal hernia. Ann Thorac Surg 72(4):1125–1129CrossRefPubMed
11.
Jobe BA et al (2002) Laparoscopic management of giant type III hiatal hernia and short esophagus. Objective follow-up at three years. J Gastrointest Surg 6(2):181–188CrossRefPubMed
12.
Diaz S et al (2003) Laparoscopic paraesophageal hernia repair, a challenging operation: medium-term outcome of 116 patients. J Gastrointest Surg 7(1):59–66CrossRefPubMed
13.
Targarona EM et al (2004) Mid term analysis of safety and quality of life after the laparoscopic repair of paraesophageal hiatal hernia. Surg Endosc 18(7):1045–1050CrossRefPubMed
14.
Andujar JJ et al (2004) Laparoscopic repair of large paraesophageal hernia is associated with a low incidence of recurrence and reoperation. Surg Endosc 18(3):444–447CrossRefPubMed
15.
16.
Wiechmann RJ et al (2001) Laparoscopic management of giant paraesophageal herniation. Ann Thorac Surg 71(4):1080–1086CrossRefPubMed
17.
White BC et al (2008) Do recurrences after paraesophageal hernia repair matter? : ten-year follow-up after laparoscopic repair. Surg Endosc 22(4):1107–1111CrossRefPubMed
18.
Ogden CL et al (2013) Prevalence of obesity among adults: United States, 2011-2012. NCHS Data Brief 131:1–8PubMed
19.
Cuenca-Abente F, Parra JD, Oelschlager BK (2006) Laparoscopic sleeve gastrectomy: an alternative for recurrent paraesophageal hernias in obese patients. JSLS 10(1):86–89PubMedCentralPubMed
20.
Rodriguez JH et al (2012) Combined paraesophageal hernia repair and partial longitudinal gastrectomy in obese patients with symptomatic paraesophageal hernias. Surg Endosc 26(12):3382–3390CrossRefPubMed
21.
Dutta SK et al (2009) Upper gastrointestinal symptoms and associated disorders in morbidly obese patients: a prospective study. Dig Dis Sci 54(6):1243–1246CrossRefPubMed
22.
Wilson LJ, Ma W, Hirschowitz BI (1999) Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol 94(10):2840–2844CrossRefPubMed
23.
Amini A, Vaziri K, Nagle AP (2008) Simultaneous laparoscopic type III paraesophageal hernia repair with porcine small intestine submucosa and Roux-en-Y gastric bypass. Surg Obes Relat Dis 4(6):764–767CrossRefPubMed
24.
Korwar V et al (2009) Laparoscopic hiatus hernia repair and simultaneous sleeve gastrectomy: a novel approach in the treatment of gastroesophageal reflux disease associated with morbid obesity. J Laparoendosc Adv Surg Tech A 19(6):761–763CrossRefPubMed
25.
Merchant AM et al (2009) Comparison between laparoscopic paraesophageal hernia repair with sleeve gastrectomy and paraesophageal hernia repair alone in morbidly obese patients. Am Surg 75(7):620–625PubMed
26.
27.
Landen S (2005) Simultaneous paraesophageal hernia repair and gastric banding. Obes Surg 15(3):435–438CrossRefPubMed
28.
Parikh M, Gagner M (2008) Laparoscopic hiatal hernia repair and repeat sleeve gastrectomy for gastroesophageal reflux disease after duodenal switch. Surg Obes Relat Dis 4(1):73–75CrossRefPubMed
29.
Pham DV et al (2014) Simultaneous laparoscopic paraesophageal hernia repair and sleeve gastrectomy in the morbidly obese. Surg Obes Relat Dis 10(2):257–261CrossRefPubMed
30.
Salvador-Sanchis JL et al (2010) Treatment of morbid obesity and hiatal paraesophageal hernia by laparoscopic Roux-en-Y gastric bypass. Obes Surg 20(6):801–803CrossRefPubMed
31.
Varela JE (2009) Laparoscopic biomesh hiatoplasty and sleeve gastrectomy in a morbidly obese patient with hiatal hernia. Surg Obes Relat Dis 5(6):707–709CrossRefPubMed
32.
Murray L et al (2003) Relationship between body mass and gastro-oesophageal reflux symptoms: the Bristol Helicobacter Project. Int J Epidemiol 32(4):645–650CrossRefPubMed
33.
Foster A et al (2003) Gastrointestinal symptoms are more intense in morbidly obese patients. Surg Endosc 17(11):1766–1768CrossRefPubMed
34.
Morgenthal CB et al (2007) Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes. Surg Endosc 21(11):1978–1984CrossRefPubMed
35.
Perez AR, Moncure AC, Rattner DW (2001) Obesity adversely affects the outcome of antireflux operations. Surg Endosc 15(9):986–989CrossRefPubMed
36.
Mercer CD et al (1987) Lower esophageal sphincter pressure and gastroesophageal pressure gradients in excessively obese patients. J Med 18(3–4):135–146PubMed
37.
Kellogg TA et al (2007) Anatomic findings and outcomes after antireflux procedures in morbidly obese patients undergoing laparoscopic conversion to Roux-en-Y gastric bypass. Surg Obes Relat Dis 3(1):52–57CrossRefPubMed
38.
39.
Diamantis T et al (2014) Review of long-term weight loss results after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 10(1):177–183CrossRefPubMed
40.
Lidor AO et al (2013) Defining recurrence after paraesophageal hernia repair: correlating symptoms and radiographic findings. Surgery 154(2):171–178CrossRefPubMed
Metadata
Title
Combining laparoscopic giant paraesophageal hernia repair with sleeve gastrectomy in obese patients
Authors
Ankit D. Patel
Edward Lin
Nathaniel W. Lytle
Juan P. Toro
Jahnavi Srinivasan
Arvinpal Singh
John F. Sweeney
S. Scott Davis Jr.
Publication date
01-05-2015
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 5/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3771-8

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