Concomitant Hiatal Repair Research Articles

Hiatoplasty for Intrathoracic Gastric Migration Associated with One Anastomosis Gastric Bypass (OAGB)

The standard of surgical correction of post-bariatric intrathoracic gastric migration (ITGM) is hiatal hernia repair, but little is known about its efficacy in patients with one anastomosis gastric bypass (OAGB). We present our experience. This retrospective cohort study includes all patients with OAGB who had undergone hiatal hernia repair from 2014 to 2019. The primary outcome was recurrence of ITGM as diagnosed by computed tomography and gastroscopy. A total of 63 patients underwent hiatal hernia repair 2-54months (median 13) after primary OAGB (40 patients) or concurrent with revisional OAGB after prior sleeve gastrectomy (23 patients). ITGM recurred in 48% of patients with hiatal repair after primary OAGB and in 91% of patients with concomitant hiatal repair. Recurrences were diagnosed after a median interval of 9 and 8.5months, respectively. Thirty-six patients (57% of total number) required a revision, and a re-recurrence of ITGM was detected in 15 patients. The Cox regression analysis of all hiatal repairs showed that two variables significantly influenced the likelihood of ITGM recurrence: the length of the migrated pouch (hazard ratio 1.32; p = 0.016) and the type of repair. Combining hiatoplasty with ligamentum teres augmentation (LTA) and conversion to Roux-en-Y gastric bypass (RYGB) lowered the probability of ITGM recurrence (compared with stand-alone hiatoplasty; hazard ratio 0.21, p = 0.029). The outcome of hiatal repair in patients with OAGB is unsatisfactory. Stand-alone hiatoplasty is particularly ineffective. The combination of hiatoplasty with LTA and conversion to RYGB improves the early results, but the long-term durability needs to be tested.

Current interventional management of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a chronic condition with a tremendous negative impact on both health-related quality of life and healthcare resource utilization. It is also a progressive disease that may lead to Barrett’s esophagus and adenocarcinoma. In addition, more than one third of GERD patients are partially responders/ non-responders to proton-pump inhibitors and there is growing concern regarding the safety of long-term pharmacological therapy. Interventional therapy in these patients can be performed either through laparoscopy or flexible endoscopy. Both methods have the potential to reinforce the lower esophageal sphincter and to protect the esophageal mucosa from retrograde flow of both acid and alkaline gastric contents. However, a concomitant hiatal repair is feasible only through a laparoscopic approach.