Laparoscopic biomesh hiatoplasty and sleeve gastrectomy in a morbidly obese patient with hiatal hernia

Abstract

The preferred operative approach for hiatal hernia repair and obesity surgery is laparoscopic. The repair of hiatal defects and fundoplication procedures in the morbidly obese can prove difficult because the amount of intra-abdominal and gastroesophageal fat can obscure important anatomic landmarks. Hiatal hernias are not uncommonly seen at bariatric surgery and very seldom are diagnosed preoperatively. Once encountered intraoperatively, these must be repaired, and a variety of techniques can be used. The size of the hiatal defect determines the type of repair and the need for prosthetic use for crural reinforcement. The use of mesh during the repair of large hiatal hernias has emerged as an evidence-based practice to reduce hiatal recurrence. However, the best material for crural reinforcement and fixation methods has not yet been standardized. Similarly, laparoscopic sleeve gastrectomy has become a popular bariatric procedure. The combined use of biomesh hiatoplasty during laparoscopic sleeve gastrectomy could prove useful in reducing the hiatal hernia recurrence rates. A case report and the laparoscopic techniques for repair of a large hiatal hernia at sleeve gastrectomy are presented.