Background: Laparoscopic sleeve gastrectomy (SG) is the most common bariatric procedure in North America. Hiatal hernias are also a very common anatomical abnormality that can complicate SG at the time of operation or develop in the post-operative phase. There is no consensus regarding the optimal management of hiatal hernias identified before, during or after bariatric surgery. Our centre has adopted the novel use of gastropexy using a soft tissue anchor after primary hiatal hernia repair with SG. This study aims to determine if gastropexy with soft tissue anchor is an effective, durable, and safe procedure to address hiatal hernias identified at same time or after SG.
Methods: Single-centre retrospective analysis of patients’ chart who underwent gastropexy with soft tissue anchor for hiatal hernias during or after SG over the last 5 years.
Results: Seven procedures were performed during the study period (Female n=7(100%), Male n=0(0%), P=0.02; Median Age=53y, Interquartile Range [IQR]=17y). Six patients had the procedure following SG and 1 had it simultaneous with SG (Time from SG to procedure, median=1451d, IQR=2577d). Type 1 hernias were more common (Type 1, 2, vs 3: N= 5(71%), 1(14%), 1(14%), P=0.05). Patients were mostly never-smokers vs ex-smokers vs current smokers (6(86%), 1(14%), vs 0(0%), P=0.01) with similar American Society of Anesthesiologists physical status class (II: 4(57%), III: 3(43%), P=0.45) and a median BMI of 38.4 (IQR = 11.6). Median length of post-operative hospital stay was 2d (IQR 2d) with one patient’s stay extended to 4 days due to an ileus following extensive lysis of adhesions and repair of enterotomies not directly related to the hernia repair. There were no other significant complications reported peri-operatively. Median follow-up time is 223d (IQR 1171d) with symptom resolution or improvement reported in all patients (5(71%) vs 2(29%) vs no improvement 0(0%), P=0.07). There were no mortalities, hospital re-admissions, and no documented recurrence of hiatal hernia by symptoms, imaging, or endoscopy in the follow-up period.
Conclusions: Gastropexy with soft tissue anchor following primary hiatal hernia repair with SG is a safe and durable procedure. Continued clinical experience with this procedure and thorough comparisons to alternative strategies are required for widescale adoption of this technique.
