EFFECT OF HIATAL HERNIA REPAIR ON GASTROESOPHAGEAL REFLUX SYMPTOMS AFTER SLEEVE GASTRECTOMY: A PROSPECTIVE OBSERVATIONAL STUDY
Mohamad Minhem, Luma Basma O. Rustom, Ala I. Sharara, Hussein H. Rimmani, Amr I. Al Abbas, Rani Shayto, Hanaa Aridi, Ayman Alrazim, Anthony Kerbage, Halim Bou Daher*, Yasser H. Shaib, Ramzi Alami, Bassem Safadi
Internal Medicine, Gastroenterology Division, American University of Beirut Medical Center, Beirut, Lebanon
Introduction: Factors leading to the development or resolution of gastroesophageal reflux (GER) post-laparoscopic sleeve gastrectomy (LSG) are poorly defined. It is unclear whether concomitant hiatal hernia repair (HHR) with LSG improves GER outcomes.
Aims: To investigate the effectiveness of HHR on GER symptoms post-LSG.
Methods: Primary LSG patients were recruited over 2-year period as part of a prospective 5-year observational study. All patients underwent preoperative endoscopy. The Gastroesophageal Reflux Disease Questionnaire (GERDQ), and Nocturnal Gastro-esophageal Reflux Disease Symptom Severity and Impact Questionnaire (N-GSSIQ) were administered preoperatively and at 6 months, 1-year and 2-year post-LSG.
Results: 150 consecutive patients were enrolled (44% males; mean age 36.8 ± 11.6; mean BMI 40.3 ± 4.7 Kg/M2). PPI use at baseline was present in 37 patients (24.7%). HHR was performed in 45 patients (30%) mainly through posterior crural repair. Patients who underwent HHR were more likely to have erosive esophagitis (44.4% vs. 24.8%, p=0.017) and to be males (60.0% vs. 37.1%, p=0.010). Follow-up assessment was completed on 112 patients (74.7%) at 6 months and 95 patients (63.3%) at 1-2 years. Patients with HHR had similar %total weight loss at last follow-up (30.9% vs. 29.9%, p=0.631). There was no difference between HHR+LSG vs. LSG with respect to GERDQ or N-GSSIQ scores and PPI use at baseline, 6 months, and at last follow-up. However, N-GSSIQ scores of 29 HHR patients dropped significantly at 1-year and 2-years (14.09 ± 13.49 vs. 3.03 ± 3.90, p<0.001).
Conclusion: Concomitant HHR during LSG is not associated with decrease in reflux symptoms immediately after surgery. However, nocturnal reflux appears to improve beyond 6 months. Longer-term follow-up is needed to establish the value of HHR in LSG.
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