Impact of Hiatal Hernia Repair Technique on Patient-Reported Gastroesophageal Reflux Symptoms following Laparoscopic Sleeve Gastrectomy

Document Type

Conference Proceeding

Publication Date

10-27-2021

Publication Title

Surg Endosc

Abstract

Introduction: Repairing a hiatal hernia at the time of laparoscopic sleeve gastrectomy (LSG) may help resolve pre-existing symptoms of gastroesophageal reflux disease (GERD) or reduce the risk for de novo GERD symptoms. However, different hiatal hernia repair techniques exist and their impact on symptom control is unclear. Methods and Procedures: Surgeons (n = 75) participating in a statewide quality collaborative were surveyed on their technique for repair of hiatal hernias during LSG. Options included anterior repair (AR), posterior repair (PR) and posterior repair with mesh (PRM). We used the GERD health-related quality of life (GERD-HRQL) survey to evaluate GERD symptoms at baseline and one year following LSG among patients who underwent concurrent hiatal hernia repair. We compared patient-reported GERD-HRQL symptom scores, total weight loss at one year, and 30-day complications among patients according to their surgeon's operative technique (AR n = 866 patients, PR n = 6,131 patients, PRM n = 886 patients). Results: According to surgeon surveys, the most commonly reported technique for hiatal hernia repair was PR (n = 64, 85.3%), followed by PRM (n = 7, 9.3%) and AR (n = 4, 5.3%). Patients who underwent LSG by surgeons who perform AR were less likely to have a baseline diagnoses of GERD (AR 55.3%, PR 59.5%, PRM 64.8%, p < 0.01), and were modestly more likely to experience worsening GERD symptoms at one year (AR 29.8%, PR 28.7%, PRM 28.2%, p < 0.0001), despite experiencing similar total body weight loss (AR 29.8%, PR 28.7%, PRM 28.2%, p = 0.08). There was no significant difference in satisfaction rates with GERD symptoms at one year (AR 73.2%, PR 76.3%, PRM 75.7%, p = 0.43), and risk-adjusted 30-day rates of hemorrhage or leak were similar among all groups. Conclusions: Patients undergoing LSG with concurrent hiatal hernia repair by surgeons who typically perform an anterior repair of a hiatal hernia were somewhat more likely to report worsening GERD at one year after surgery despite excellent weight loss. However, overall satisfaction with GERD symptoms after LSG is high, regardless of technique, indicating that symptom control for GERD may be multifactorial.

Volume

35

Issue

1

First Page

S75

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