Siegel Leon, Carroll Rory, Thompson Dakota T, Lehmann Ryan, Smith Jessica, Nau Peter
Department of Surgery, University of Iowa Health Care, 200 Hawkins Dr, Iowa City, IA, 4628 JCP, USA.
Surg Endosc. 2025 Jun 16. doi: 10.1007/s00464-025-11854-7.
Minimally invasive hiatal hernia repair with fundoplication (HHR) is the standard of care for hiatal hernias but has a high risk of recurrence even in populations without obesity. Concomitant roux-en-y gastric bypass (RYGB) with HHR may mitigate the increased risk of hiatal hernia recurrence in patients with obesity while also addressing obesity-related comorbidities. There is a paucity of data on this procedure. It is hypothesized that a concomitant RYGB with HHR is safe and effective in patients with obesity.
This is a single institution retrospective review of adult patients who underwent concomitant RYGB with HHR from 2014-2023. Patient charts were reviewed to collect data on complications, weight loss, GERD symptom resolution, and improvement in other obesity-related comorbidities. Outcomes were measured at one-, three-, and five-year follow-up.
Sixty-four patients met inclusion criteria. Fifty-three patients had primary and eleven patients had revisional surgery. There was one (2%) perioperative complication that required intervention, three (4%) unplanned readmissions for PO intolerance, and four patients (8%) treated for marginal ulcer. Resolution of heartburn/reflux symptoms was 86% at one year, 70% at 3 year, and 59% at 5 year follow-up. Improvement in diabetes (80%), hypertension (75%), and hyperlipidemia (33%) were noted at 5 years. The change in BMI and %TWL at 5 years for primary procedures was -11.5 kg/m and 37.7%, respectively. For revisional procedures, change in BMI was -2.4 kg/m and %TWL was 3.6%.
Durability of a HHR in the setting of obesity is poor. Concomitant RYGB with HHR is safe and effective for treating GERD while also improving obesity and obesity-associated comorbidities.
采用胃底折叠术的微创食管裂孔疝修补术（HHR）是食管裂孔疝的标准治疗方法，但即使在非肥胖人群中也有较高的复发风险。HHR联合Roux-en-Y胃旁路术（RYGB）可能会降低肥胖患者食管裂孔疝复发风险增加的情况，同时还能解决与肥胖相关的合并症。关于该手术的数据较少。据推测，HHR联合RYGB对肥胖患者是安全有效的。
这是一项单机构回顾性研究，纳入了2014年至2023年期间接受HHR联合RYGB的成年患者。查阅患者病历以收集并发症、体重减轻、胃食管反流病（GERD）症状缓解情况以及其他肥胖相关合并症改善情况的数据。在1年、3年和5年随访时测量结果。
64例患者符合纳入标准。53例患者接受初次手术，11例患者接受翻修手术。有1例（2%）围手术期并发症需要干预，3例（4%）因口服不耐受意外再次入院，4例（8%）接受边缘性溃疡治疗。烧心/反流症状的缓解率在1年时为86%，3年时为70%，5年时为59%。5年时糖尿病（80%）、高血压（75%）和高脂血症（33%）有所改善。初次手术5年时BMI的变化为-11.5kg/m²，体重减轻百分比（%TWL）为37.7%。翻修手术时，BMI变化为-2.4kg/m²，%TWL为3.6%。
肥胖情况下HHR的持久性较差。HHR联合RYGB在治疗GERD方面安全有效，同时还能改善肥胖及肥胖相关合并症。
