Matar, M., Makram, F., Afifi, A. (2022). Laparoscopic Sleeve Gastrectomy with or without Hiatal Hernia Repair: Effect on Gastroesophageal Reflux Disease in Morbidly Obese Patients. The Egyptian Journal of Hospital Medicine, 89(1), 5482-5487. doi: 10.21608/ejhm.2022.264845
Mohammed Matar; Fady Makram; Amr Afifi. "Laparoscopic Sleeve Gastrectomy with or without Hiatal Hernia Repair: Effect on Gastroesophageal Reflux Disease in Morbidly Obese Patients". The Egyptian Journal of Hospital Medicine, 89, 1, 2022, 5482-5487. doi: 10.21608/ejhm.2022.264845
Matar, M., Makram, F., Afifi, A. (2022). 'Laparoscopic Sleeve Gastrectomy with or without Hiatal Hernia Repair: Effect on Gastroesophageal Reflux Disease in Morbidly Obese Patients', The Egyptian Journal of Hospital Medicine, 89(1), pp. 5482-5487. doi: 10.21608/ejhm.2022.264845
Matar, M., Makram, F., Afifi, A. Laparoscopic Sleeve Gastrectomy with or without Hiatal Hernia Repair: Effect on Gastroesophageal Reflux Disease in Morbidly Obese Patients. The Egyptian Journal of Hospital Medicine, 2022; 89(1): 5482-5487. doi: 10.21608/ejhm.2022.264845
Laparoscopic Sleeve Gastrectomy with or without Hiatal Hernia Repair: Effect on Gastroesophageal Reflux Disease in Morbidly Obese Patients
Department of General Surgery, Faculty of Medicine, Ain Shams University
Abstract
Background:Gastroesophageal reflux disease (GERD) is considered an obesity-related comorbidity. Hiatal hernia (HH) plays a role in the pathophysiology of GERD in the obese population. Roux-en-Y gastric bypass is considered the operation of choice when GERD is diagnosed in these population, the effect of laparoscopic sleeve gastrectomy (LSG) with hiatal hernia repair (HHR) on GERD still debated. Objective: To compare the outcomes of performing LSG with concomitant HHR vs LSG alone in patients with GERD. Patients and Methods: This was a retrospective analysis of maintained data of 241 patients undergoing LSG after refusing to undergo a bypass surgery in the Bariatric Surgery Department, Ain Shams University Hospital. The difference in outcomes between performing LSG with concomitant HHR and performing LSG alone was analyzed. The interest outcomes were postoperative GERD symptoms, development of de novo GERD, postoperative complications, resolution of comorbidities, and excess weight loss. Results: Preoperatively, 129 patients (53.5%) had mild GERD symptoms while 33 patients (13.7%) had moderate GERD symptoms, and the rest of the patients were asymptomatic for GERD. Seventy-five patients (31.12%) were diagnosed with HH by endoscopy preoperatively out of which 11 patients were asymptomatic for GERD. Intraoperatively, 35 patients (14.5%) were diagnosed with HH 4-5 cm in diameter, 67 patients (27.8%) were diagnosed with HH smaller than 2 cm in diameter and 42 patients (17.4%) had only small depression or weakness among the intercrural fibers with no actual defect in the hiatus. Conclusion: LSG with concomitant HHR provides adequate management of GERD and should be performed if HH diagnosis was made in obese population as it’s feasible and safe.
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