Background

Obesity is a condition that is well known to contribute to the development of gastroesophageal reflux (GERD). A significant portion of patients with obesity report symptoms of GERD such as heartburn, regurgitation, and nausea. The development of GERD is multi-factorial and as experience shows, sleeve gastrectomy contributes to GERD symptoms post-operatively. We sought to determine if the presence of a hiatal hernia and its repair during sleeve gastrectomy impacts patient symptomatology related to GERD post-operatively. To study this query, patients that underwent sleeve gastrectomy completed a questionnaire pre- and post-operatively regarding their symptoms of GERD. Intraoperatively, many patients were noted to have small (1-3cm) hiatal hernias which were repaired primarily with a non-absorbable suture. All patients had a 36Fr bougie placed and once access to the abdomen was established the diaphragmatic hiatus was examined. If an indentation was observed, an anterior and posterior crural approximation with non-absorbable suture was performed. Those patients that underwent sleeve gastrectomy with repair of hiatal hernia and their responses to the questionnaires were then examined. The findings indicate that many patients who reported symptoms indicative of GERD pre-operatively and subsequently underwent sleeve gastrectomy with hiatal hernia repair had substantial reduction or complete resolution of their symptoms post-operatively. In addition, no patients complained of dysphagia post-operatively. These results suggest that the primary repair of even small hiatal hernias concurrently with sleeve gastrectomy may provide relief of GERD symptoms or prevent symptoms post-operatively in patients with obesity while also not contributing to complications such as dysphagia.