Laparoscopic Hiatus Hernia Repair and Simultaneous Sleeve Gastrectomy: A Novel Approach in the Treatment of Gastroesophageal Reflux Disease Associated with Morbid Obesity

Abstract

Obesity is associated with significantly increased risk of gastroesophageal reflux disease and recurrence of reflux symptoms following surgical intervention, compared to individuals with normal body-mass index (BMI). The severity of reflux symptoms and obesity is associated with a decreased quality of life. In this article, we report a novel approach to the treatment of morbid obesity and hiatus hernia in a 36-year-old female with a BMI of 40 kg/m(2) who failed the conservative treatment. A laparoscopic hiatal repair, using a commercially available on lay reinforcement biologic mesh and a sleeve gastrectomy performed at the same time was successful in controlling the reflux symptoms and reducing her body weight.

Laparoscopic Sleeve Gastrectomy in Patients With Preexisting Gastroesophageal Reflux Disease

“…These details include attention to the sleeve size and volume, avoidance of narrowing the gastric body or pylorus, and identification and repair of all associated hiatal hernias. 36,39,40,[43][44][45][46] One series demonstrated that attention to crural repair during LSG resulted in GERD remission in 73% and a decrease in the development of de novo GERD from 23% to 0%. 43 These series suggest that technical modification may have a major role in reducing the risk of postoperative GERD with LSG but require larger samples and longer follow-up periods.…”

Laparoscopic and Robotic Sleeve Gastrectomy: Short- and Long-Term Results

“…It is also important to mention that the prevalence of hiatal hernia in the morbidly obese is nearly 40 % [45], suggesting that surgeons should evaluate whether patients need to have a hiatal hernia repair at the same time of sleeve gastrectomy, particularly if the patient has previous GERD symptoms [46][47][48]. In the robotic group, another factor that could explain a longer operative time was related to the fact that it was used as a surgical training model, Romero et al [37] reported a length of stay in the robotic group of 2.2 days compared to 3.3 days in the systematic review (p=<0.005).…”

Does concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair increase morbidity?

“…There are also articles in the literature reporting that HHR was performed safely with a mesh after SG [21,22]. In our study, no prosthetic material was used in any patient.…”