Laparoscopic Crural Repair With Simultaneous Sleeve Gastrectomy: A Way in Gastroesophageal Reflux Disease Treatment Associated With Morbid Obesity

Abstract

Background: Laparoscopic sleeve gastrectomy (LSG) has become popular both as a definitive and a staged procedure for morbid obesity. Gastroesophageal reflux disease (GERD) is a common co-morbid disease in bariatric patients.\r\n Objectives: The aim of this study was to evaluate the efficacy of LSG and hiatal hernia repair (HHR) to treat obesity, complicated by hiatus hernia (HH). Patients and Methods: The participants in the study were twenty patients, 14 women and 6 men, with a mean body mass index of 43.4 1.9 kg/m2 and mean age of 47 years. All the subjects were eligible for LSG and eight were found to have esophagitis at pre-operative endoscopy. Patients with Barretts esophagus were excluded. GERD symptom questionnaire, 24-hour esophageal pH-metry, and manometry were employed as Pre-and post-procedure assessments. The mean follow-up period was eight months. Clinical outcomes were also evaluated in terms of GERD symptoms improvement or resolution, interruption of antireflux medication, and X-ray evidence of HH recurrence. Results: Symptomatic HH was diagnosed preoperatively in 18 patients. In the other two patients, HH was asymptomatic and was diagnosed intra-operatively. Prosthetic reinforcement of crural closure was performed in two symptomatic cases with an HH > 5 cm. Mortality was nil and no complications occurred. After a mean follow-up of seven months, GERD symptoms resolution occurred in nine patients, while the other patients reported an improvement of reflux. Body mass index had fallen from 43.4 to 36.2 kg/m2. Conclusions: A laparoscopic hiatal repair with or without commercially available onlay reinforcement biologic mesh and a sleeve gastrectomy performed at the same time, was successful in controlling the reflux symptoms and reducing body weight.