Concurrent hiatal hernia repair and bariatric surgery: outcomes after sleeve gastrectomy and Roux-en-Y gastric bypass

Oct 28, 2020Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

Results of repairing hiatal hernia during two types of weight-loss surgery: sleeve gastrectomy and gastric bypass

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Abstract

A total of 73% of patients had a full year of postoperative enrollment.

Patients undergoing concurrent sleeve gastrectomy (SG) and hiatal hernia repair (HHR) were 2.1 times more likely to require additional abdominal operations within one year compared to those who had SG alone.
The likelihood of needing endoscopies was 1.5 times higher for SG patients with HHR than for those without by one year post-surgery.
No significant difference in the rate of bariatric revisions or conversions was observed for SG patients with HHR compared to those without.
Among Roux-en-Y gastric bypass (RYGB) patients, concurrent HHR was associated with a 1.4 times increased risk of endoscopy at one year, with this association persisting at three years.
The patterns of increased risk for surgical and non-surgical interventions varied between SG and RYGB patients.

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BACKGROUND: Hiatal hernias are often repaired concurrently with bariatric surgery to reduce risk of gastroesophageal reflux disease-related complications.

OBJECTIVES: To examine the association between concurrent hiatal hernia repair (HHR) and bariatric outcomes.

SETTING: A 2010-2017 U.S. commercial insurance claims data set.

METHODS: We conducted a retrospective cohort study. We identified adults who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) alone or had bariatric surgery concurrently with HHR. We matched patients with and without HHR and followed patients up to 3 years for incident abdominal operative interventions, bariatric revisions/conversions, and endoscopy. Time to first event for each outcome was compared using multivariable Cox proportional hazards modeling.

RESULTS: We matched 1546 SG patients with HHR to 3170 SG patients without HHR, and we matched 457 RYGB patients with HHR to 1156 RYGB patients without HHR. A total of 73% had a full year of postoperative enrollment. Patients who underwent concurrent SG and HHR were more likely to have additional abdominal operations (adjusted hazard ratio [aHR], 2.1; 95% CI, 1.5-3.1) and endoscopies (aHR, 1.5; 95% CI, 1.2-1.8) but not bariatric revisions/conversions (aHR, 1.7; 95% CI, .6-4.6) by 1 year after surgery, a pattern maintained at 3 years of follow-up. Among RYGB patients, concurrent HHR was associated only with an increased risk of endoscopy (aHR, 1.4; 95% CI, 1.1-1.8)) at 1 year of follow-up, persisting at 3 years.

CONCLUSIONS: Concurrent SG/HHR was associated with increased risk of some subsequent operative and nonoperative interventions, a pattern that was not consistently observed for RYGB. Additional studies could examine whether changes to concurrent HHR technique could reduce risk.

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Concurrent hiatal hernia repair and bariatric surgery: outcomes after sleeve gastrectomy and Roux-en-Y gastric bypass

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