Crural Repair Permits Morbidly Obese Patients with Not Large Hiatal Hernia to Choose Laparoscopic Adjustable Banding as a Bariatric Surgical Treatment

Abstract

Crural repair permits LAGB to be safely and effectively performed in patients with hiatal hernia.

Initial Experience with Laparoscopic Crural Closure in the Management of Hiatal Hernia in Obese Patients Undergoing Sleeve Gastrectomy

“…Nevertheless, in obese patients, antireflux procedures such as laparoscopic Nissen fundoplication have been reported to have a high recurrence rate [17][18][19]. As a result, bariatric operations such as LGB and LRYGBP have been considered as both antireflux and restrictive procedures because of their effectiveness on weight loss and restoration of cardioesophageal competence [20][21][22][23][24][25][26][27][28][29][30].…”

“…At the beginning, LGB seemed to be contraindicated in obese patients with HH, because of the increased risk of band slippage or dysphagia [34], and afterward has been proven by several authors that crural repair in addition to gastric banding does not increase the risk of slippage or dysphagia and significantly improves reflux symptoms, providing an increase in lower esophageal sphincter pressure [20][21][22][23][24].…”

“…Nevertheless recent studies have demonstrated that obesity plays an adverse role on long-term clinical outcomes of LARS [17][18][19]. As a result, bariatric procedures as laparoscopic gastric banding (LGB) with hiatal hernia repair (HHR) [20][21][22][23][24] and laparoscopic Roux-en-Y gastric bypass (LRYGBP) [25][26][27][28][29][30] have been proposed by several authors for the synchronous treatment of morbid obesity and GERD with or without HH, providing good results in terms of excess weight loss and reflux symptoms improvement.…”

Impact of concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair on gastro-oesophageal reflux disease in morbidly obese patients

“…[8910] Laparoscopic roux-en-y bypass (LRYGB) with or without crural closure is known to improve GERD and HH. [111213141516] However, there are few studies which address the impact of laparoscopic sleeve gastrectomy (LSG) with crural closure on GERD in morbidly obese patients having HH. Moreover, the results of these studies are conflicting.…”

Radiographic Predictability of Hiatal Hernia Prior to Gastric Band Surgery

“…Thus repairing the comorbid HH while simultaneously placing the gastric band is now a standard surgical approach. 2,3 This approach has been shown to decrease overall rates of reoperation for LAGB recipients. 4,5 …”