Background

Hiatal hernia (HH), which can be related to GERD, is frequently identified and repaired during laparoscopic sleeve gastrectomy (LSG). Objectives To prospectively evaluate the long-term effects of hiatal hernia repair (HHR) during LSG.

Methods

As part of a prospective randomized trial evaluating the role of routine posterior crural inspection during LSG, we analyzed long-term data for an initial cohort of patients undergoing LSG with and without HHR. At time of surgery, patients with anteriorly visible HH underwent HHR followed by LSG. All others were randomized to standalone LSG vs posterior crural inspection with repair of any identified HH, followed by LSG. At minimum 2-year follow-up, outcomes of both groups were compared.

Results

Between November 2019 and June 2020, 100 patients participated in the study and 55 patients provided long-term data. Of these patients, 27 underwent LSG with HHR (81.5% female, 49.7 +- 10.5 years) and 28 standalone LSG (75.0% female, 42.2 +- 11.8 years). At 2 years, weight loss (21.6% +- 11.8% vs 22.9% +- 10%, p=.65) and GERD resolution (60.0% vs 62.5%, p=.89) were similar in those undergoing LSG with and without HHR. Rates of de novo GERD (25.0% vs 33.3%, p=.65) and postoperative antisecretory use (22.2% vs 32.1%, p=.41) were also not significantly different.

Conclusions

Concomitant HHR during LSG is safe and yields similar weight loss and comorbidity resolution as standalone LSG. Performing concomitant HHR appears to lower post operative GERD rates to similar levels as those patients without preoperative hiatal hernias.