Geisinger Health System, 100 North Academy Avenue, Danville, 17822, PA, USA.
Geisinger Commonwealth School of Medicine, 525 Pine Street, Scranton, 18509, PA, USA.
Surg Endosc. 2024 Oct;38(10):5974-5979. doi: 10.1007/s00464-024-11083-4. Epub 2024 Jul 30.
This study presents a case series of "de novo" paraesophageal hernia (dnPEH) in post-Roux-en-Y gastric bypass (RYGB) patients and analyzes the predisposing factors, symptoms, and outcomes after repair. This is a lesser known complication after RYGB and when symptomatic, may warrant surgery.
A retrospective review of data from a single academic institution from 2002 to 2022 was performed identifying patients who developed dnPEH after RYGB and compared them to patients with primary RYGB without post-operative symptomatic dnPEH. Patient characteristics from initial RYGB were analyzed to identify predisposing factors for dnPEH development. Additional information analyzed included time to dnPEH repair, indications for surgery, types of herniation, type of surgical repair, and symptom resolution.
There were 6975 RYGB in the study period of which 6619 underwent RYGB alone at index surgery, with 31 of those patients developing late stage PEH requiring repair. Patients with older age (51.8 years with dnPEH vs 45.2 years without, p = 0.001) and increased weight loss at 1 year (33.4% vs 30.5%, p = 0.048) from index RYGB were more likely to develop dnPEH. The incidence of dnPEH was 31/6619 (0.47%). Late dnPEH after RYGB took an average of 74 months (45-102 months IQR) to develop symptoms and undergo repair. The most common symptoms were heartburn/reflux 19/31 (61.3%) and epigastric pain 13/31 (41.9%). Symptom resolution rate after repair was highest with 100% for globus and 89.5% heartburn/reflux. The most common form of dnPEH was pouch herniation in 25/31. Surgical repair most commonly included primary cruroplasty alone in 25/31 with additional mesh in 1 case. Recurrence rate was 2/31 (6.54%).
Late dnPEH after RYGB is an emerging entity typically occurring years after index RYGB. Symptomatic patients with dnPEH warrant hernia repair and responded well to surgical repair in this case series.
本研究报告了 Roux-en-Y 胃旁路术（RYGB）后新发食管裂孔疝（dnPEH）的病例系列，并分析了其修复后的易患因素、症状和结果。这是 RYGB 术后不太常见的并发症，当出现症状时，可能需要手术治疗。
对 2002 年至 2022 年期间单所学术机构的数据进行回顾性分析，确定在 RYGB 后发生 dnPEH 的患者，并将其与无术后症状性 dnPEH 的原发性 RYGB 患者进行比较。分析初始 RYGB 患者的特征，以确定 dnPEH 发生的易患因素。分析的其他信息包括 dnPEH 修复的时间、手术指征、疝类型、手术修复类型和症状缓解情况。
在研究期间，共有 6975 例 RYGB，其中 6619 例在指数手术中仅行 RYGB，其中 31 例发生晚期 PEH 需要修复。年龄较大的患者（dnPEH 组 51.8 岁，无 dnPEH 组 45.2 岁，p=0.001）和 RYGB 后 1 年体重减轻较多的患者（dnPEH 组 33.4%，无 dnPEH 组 30.5%，p=0.048）更易发生 dnPEH。dnPEH 的发生率为 31/6619（0.47%）。RYGB 后晚期 dnPEH 出现症状并接受修复的平均时间为 74 个月（45-102 个月 IQR）。最常见的症状是烧心/反流 19/31（61.3%）和上腹痛 13/31（41.9%）。修复后的症状缓解率最高，球囊感为 100%，烧心/反流为 89.5%。最常见的 dnPEH 类型是袋疝，25/31 例。手术修复最常见的是单纯原发性横结肠成形术，25/31 例，1 例加用网片。复发率为 2/31（6.54%）。
RYGB 后晚期 dnPEH 是一种新出现的实体，通常发生在 RYGB 指数后数年。有症状的 dnPEH 患者需要疝修复，在本病例系列中，手术修复效果良好。
