Concurrent hiatal hernia repair and gastric bypass as an adjunct in the treatment of hiatal hernia in populations with obesity.

BACKGROUND

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.

METHODS

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.

RESULTS

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%.

CONCLUSION

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.