Background

There's an increasing consensus favoring the identification of hiatal hernia (HH) during sleeve gastrectomy (SG) and subsequent hiatal hernia repair (HHR) when identified. This study evaluates the safety and incidence of GERD associated with simultaneous SG+HHR surgery compared to SG alone.

Methods

Following PRISMA guidelines, a systematic literature review was conducted. The random effects model used odds ratios (OR) for dichotomous data and mean differences (MD) for continuous data as effect size metrics.

Results

SG+HHR demonstrated a significantly shorter length of stay (MD -0.18, 95%CI -0.29 to -0.06, p = 0.003) and significantly lower incidences of de novo (new onset) GERD cases (OR 0.65, 95%CI 0.42 - 0.99, p = 0.04). However, SG+HHR was associated with a significantly higher incidence of readmissions (OR 1.30, 95%CI 1.05 - 1.61, p = 0.02). Additionally, SG+HHR showed non-significant decreases in leaks and bleeding, as well as no significant changes in total weight loss (TWL%) and excess weight loss (EWL%) 12 months postoperatively. There was also a non-significant increase in reoperations associated with SG+HHR.

Conclusions

SG+HHR appears to be safe and potentially effective in reducing the incidence of de novo GERD. Routine consideration of HHR during SG is suggested.