Background

The incidence of SG to RYGB conversion (C-RYGB) has increased recently, with GERD being the most common indication. Thus, it is imperative to identify the presence of a HH at the time of conversion. Herein, using the MBSQIP database, the outcomes between C-RYGB with HHR and C-RYGB alone were compared.

Methods

Patients who underwent C-RYGB with HHR and C-RYGB alone within the 2020-2021 MBSAQIP database were included. Using propensity score matching (PSM) analysis, the cohorts were matched for 23 preoperative characteristics. We then compared 30-day postoperative outcomes between C-RYGB with HHR versus C-RYGB alone.

Results

13,037 patients were identified. The matched cohorts (n= 1921) had similar pre-operative characteristics. After PSM, patients in the C-RYGB with HHR group showed longer operative times (157.79 +- 68.74 min vs 144.26 +- 66.94 min, p<0.001). Similarly, significantly higher rates of readmissions (8.7% vs 6.3%, p=0.005) and interventions (3.4% vs 2.4%, p=0.048) were found among those who underwent C-RYGB with HHR when compared to C-RYGB alone. However, there were no significant differences in mortality, cardiac pulmonary, renal complications, blood transfusions, and bariatric-specific complications such as anastomotic leak, postoperative bleeding, and strictures.

Conclusions

Concurrent hiatal hernia repair with sleeve to Roux-en-Y gastric bypass conversion is safe and feasible. Although it was associated with longer operative times and higher rates of readmissions and interventions, there were no differences in mortality, cardiac, pulmonary complications, and bariatric-specific complications such as anastomotic leak, bleeding or strictures.