Background

Minimally invasive hiatal hernia repair, HHR, with fundoplication is the current standard of care for hiatal hernias but has significant risk of recurrence even in those populations without obesity. There is a paucity of data on the safety and efficacy of a roux-en-y gastric bypass, RYGB, with concomitant HHR.

Methods

A retrospective review of data from a single institution was performed. Data was collected on patients who underwent a RYGB and HHR from 2014-2023. Patients were excluded when lost to follow-up prior to 1 year (11 patients) or had a revisional surgery(15 patients). Forty-nine patients were ultimately included for review. Baseline data for weight and medications were recorded at enrollment in the bariatric program and at the time of their dietary compliance visit, respectively, then again at one year.

Results

There was one perioperative complication for a pneumothorax that required intervention. Two patients (4%) had unplanned readmissions for PO intolerance, and four patients (8%) were treated for marginal ulcer. Resolution of heartburn and reflux symptoms was 88% at one year. All ten patients on medications for diabetes either stopped them or were reduced to a lower dose. For patients with hypertension, 63% were on a lower dose or off all medications. The average change in BMI was 13.2, excess weight loss 60%, and total body weight loss 30%.

Conclusions

Durability of a HHR in the setting of obesity is poor. A RYGB with concurrent HHR is safe and effective at treating symptoms of GERD while also improving obesity-associated comorbidities.