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

Abstract

IntroductionObesity not only leads to susceptibility to gastroesophageal reflux disease but also is itself an important independent risk factor for the development of hiatal hernia. A coexisting hiatal hernia is found in half of obese patients with gastroesophageal reflux disease symptoms. Sleeve gastrectomy is the most commonly used restrictive method in obesity surgery. In obese patients who are scheduled to undergo sleeve gastrectomy (SG) and have a hiatal hernia, hiatal hernia repair (HHR) can be combined with SG.Material and methodsPatients who underwent SG due to morbid obesity were retrospectively evaluated. Patients who had a body mass index of > 40 kg/m² and who were diagnosed with hiatal hernia by preoperative endoscopy or intraoperatively were included in the study.ResultsA total of 30 patients who underwent SG and hiatal hernia repair were included in the study. Six patients were diagnosed with hiatal hernia by preoperative endoscopy. Twenty-four patients were intraoperatively diagnosed with hiatal hernia. The hiatal defect was repaired by suturing both anteriorly and posteriorly. There were no intraoperative or postoperative complications in any patient. The mean hospital length of stay was 3.46 days (range: 3–6). The mean follow-up time was 11.9 months (range: 4–21). Thirteen patients received medication due to acid reflux symptoms in the preoperative period. Twelve patients received no medication after surgery. One patient received low-dose medication.ConclusionsIn bariatric surgery patients with hiatal hernia, HHR should also be performed. Sleeve gastrectomy + HHR is a safe and effective method for morbidly obese patients with hiatal hernia.