Department of Surgery, University of Michigan, 1500 E Medical Center Drive, SPC 5343, 2210 Taubman Center, Ann Arbor, MI, 48109, USA.
Center for Healthcare Outcomes & Policy, Ann Abor, MI, USA.
Surg Endosc. 2021 Jun;35(6):2537-2542. doi: 10.1007/s00464-020-07668-4. Epub 2020 Jun 1.
Hiatal hernia repair performed at the time of laparoscopic sleeve gastrectomy (LSG) may reduce post-operative reflux symptoms. It is unclear whether intra-operative diagnosis of hiatal hernia varies among surgeons or if it affects outcomes.
Surgeons (n = 38) participating in a statewide bariatric surgery quality improvement collaborative reviewed 33 videos of LSG in which no hiatal hernia repair was performed. Reviewers were blinded to patient information and were asked whether they perceived a hiatal hernia. Surgeon characteristics and surgeon-specific patient outcomes for LSG were compared between surgeons who identified at least one hiatal hernia during video review and those who did not.
Ten surgeons (26%) identified at least one hiatal hernia after reviewing the videos. There were no significant differences in operative experience or practice type between surgeons who did and did not identify hiatal hernias. Surgeons who identified a hiatal hernia more often performed concurrent hiatal hernia repair in their practice when compared to those who did not (43.0% versus 36.5%, p < 0.001). Although complication rates were similar between surgeon groups, there were higher rates of de novo reflux symptoms (13.6% versus 11.1%, p = 0.032) and lower rates of antacid discontinuation at one-year (71.0% versus 77.2%, p = 0.043) among surgeons who identified hiatal hernias.
Surgeons who identified hiatal hernias during video review had a higher rate of concurrent hiatal hernia repairs in their practice. This was not associated with improved patient-reported reflux symptoms after LSG. Standardizing identification and management of hiatal hernias during bariatric surgery may help improve reflux outcomes post-operatively.
腹腔镜袖状胃切除术（LSG）时行食管裂孔疝修补术可能会减少术后反流症状。目前尚不清楚外科医生术中对食管裂孔疝的诊断是否存在差异，或者是否会影响手术结果。
参与全州范围减重手术质量改进合作的外科医生（n=38）回顾了 33 例未行食管裂孔疝修补术的 LSG 视频。审查者对患者信息不知情，并被要求判断是否存在食管裂孔疝。比较了在视频审查中识别出至少 1 例食管裂孔疝的外科医生和未识别出食管裂孔疝的外科医生的手术特征和 LSG 患者的具体结局。
10 名外科医生（26%）在查看视频后至少识别出 1 例食管裂孔疝。识别出食管裂孔疝的外科医生和未识别出食管裂孔疝的外科医生在手术经验或手术类型方面没有显著差异。与未识别出食管裂孔疝的外科医生相比，识别出食管裂孔疝的外科医生在其手术中更常同时行食管裂孔疝修补术（43.0%比 36.5%，p<0.001）。尽管两组外科医生的并发症发生率相似，但识别出食管裂孔疝的外科医生中，新发反流症状的发生率更高（13.6%比 11.1%，p=0.032），且术后 1 年停止使用抗酸剂的比例更低（71.0%比 77.2%，p=0.043）。
在视频审查中识别出食管裂孔疝的外科医生在其手术中更常同时行食管裂孔疝修补术。这与 LSG 后患者报告的反流症状改善无关。在减重手术中标准化食管裂孔疝的识别和管理可能有助于改善术后反流结局。
