A629 Laparoscopic Roux-En-Y Gastric Bypass and Repair of Type III Paraesophageal Hernia with Biosynthetic Mesh Reinforcement

Abstract

Morbid obesity is associated with an increased rate of hiatal and paraesophageal hernias (PEH). Concomitant repair at the time of Roux-En-Y gastric bypass is technically feasible, safe, and lowers recurrence rates; however, the ideal operative management remains controversial. The use of reinforcing mesh may further lower recurrence rates in the bariatric patient population. The patient is a 49 year-old female with a history of morbid obesity (BMI 42) and long-standing reflux with dysphagia. Preoperative endoscopy was notable for esophagitis and a moderate-sized PEH. Esophageal manometry revealed impaired esophageal motility with incomplete relaxation of the lower esophageal sphincter. Due to the patient’s significant reflux symptoms, a laparoscopic Roux-En-Y gastric bypass and PEH repair with mesh was recommended. This video demonstrates the techniques utilized.