Skip to main content
Erschienen in: Obesity Surgery 10/2012

01.10.2012 | Clinical Research

Impact on Perioperative Outcomes of Concomitant Hiatal Hernia Repair with Laparoscopic Gastric Bypass

verfasst von: Vishal Kothari, Abhijit Shaligram, Jason Reynoso, Elizabeth Schmidt, Corrigan L. McBride, Dmitry Oleynikov

Erschienen in: Obesity Surgery | Ausgabe 10/2012

Einloggen, um Zugang zu erhalten

Abstract

Background

The role of laparoscopic hiatal hernia repair (LHHR) at the time of laparoscopic Roux-en-y gastric bypass (LRYGB) is still debatable. This study aims to assess the safety of concomitant LHHR with LRYGB.

Methods

This study is a multi-center, retrospective analysis of a large administrative database. The University Health System Consortium (UHC) is a group of 112 academic medical centers and 256 of their affiliated hospitals. The UHC database was queried using International Classification of Diseases—9 codes and main outcome measures were analyzed.

Results

From October 2006 to January 2010, we found 33,717 patients who underwent LRYGB and did not have a hiatal hernia. In this same time period, 644 patients underwent concomitant LRYGB and LHHR, while 1,589 patients underwent LRYGB without repair of their hiatal hernias. On comparison of patients undergoing LRYGB with simultaneous LHHR with those who underwent LRYGB without a diagnosis of HH, there was no significant difference in mortality, morbidity, length of stay (LOS), 30-day readmission, or cost shown. On comparison of patients with HH who underwent LRYGB and simultaneous LHHR with those who had LRYGB without LHHR, no significant difference with regards to all the outcome measures was also shown.

Conclusions

In conclusion, concomitant hiatal hernia repair with LRYGB appears to be safe and feasible. These patients did not have any significant differences in morbidity, mortality, LOS, readmission rate, or cost. Randomized controlled studies should further look into the benefit of hiatal hernia repair in regards to reflux symptoms and weight loss for LRYGB patients.
Literatur
1.
Zurück zum Zitat Friedenberg FK, Xanthopoulos M, Foster GD, et al. The association between gastroesophageal reflux disease and obesity. Am J Gastroenterol. 2008;103:2111.PubMedCrossRef Friedenberg FK, Xanthopoulos M, Foster GD, et al. The association between gastroesophageal reflux disease and obesity. Am J Gastroenterol. 2008;103:2111.PubMedCrossRef
2.
Zurück zum Zitat Varela JE, Hinojosa M, Nguyen N. Correlations between intra-abdominal pressure and obesity-related co-morbidities. Surg Obes Relat Dis. 2009;5:524.PubMedCrossRef Varela JE, Hinojosa M, Nguyen N. Correlations between intra-abdominal pressure and obesity-related co-morbidities. Surg Obes Relat Dis. 2009;5:524.PubMedCrossRef
3.
Zurück zum Zitat Dutta SK, Arora M, Kireet A. at al. Upper gastrointestinal symptoms and associated disorders in morbidly obese patients: a prospective study. Dig Dis Sci. 2009;54:1243–6.PubMedCrossRef Dutta SK, Arora M, Kireet A. at al. Upper gastrointestinal symptoms and associated disorders in morbidly obese patients: a prospective study. Dig Dis Sci. 2009;54:1243–6.PubMedCrossRef
4.
Zurück zum Zitat Sise A, Friedenberg FK. A comprehensive review of gastroesophageal reflux disease and obesity. Obes Rev. 2008;9:194–203.PubMedCrossRef Sise A, Friedenberg FK. A comprehensive review of gastroesophageal reflux disease and obesity. Obes Rev. 2008;9:194–203.PubMedCrossRef
5.
Zurück zum Zitat Perez AR, Moncure AC, Rattner DW. Obesity is a major cause of failure for both abdominal and transthoracic antireflux operations. Gastroenterology. 1999;116:A1343. Perez AR, Moncure AC, Rattner DW. Obesity is a major cause of failure for both abdominal and transthoracic antireflux operations. Gastroenterology. 1999;116:A1343.
6.
Zurück zum Zitat Perez AR, Moncure AC, Rattner DW. Obesity adversely affects the outcome of antireflux operations. Surg Endosc. 2001;15:986–9.PubMedCrossRef Perez AR, Moncure AC, Rattner DW. Obesity adversely affects the outcome of antireflux operations. Surg Endosc. 2001;15:986–9.PubMedCrossRef
7.
Zurück zum Zitat Salvador-Sanchis JL, Martinez-Ramos D, Herfarth A, et al. Treatment of morbid obesity and hiatal paraesophageal hernia by laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2010;20:801–3.PubMedCrossRef Salvador-Sanchis JL, Martinez-Ramos D, Herfarth A, et al. Treatment of morbid obesity and hiatal paraesophageal hernia by laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2010;20:801–3.PubMedCrossRef
8.
Zurück zum Zitat Raftopoulos I, Awais O, Courcoulas AP, et al. Laparoscopic gastric bypass after antireflux surgery for the treatment of gastroesophageal reflux in morbidly obese patients: initial experience. Obes Surg. 2004;14:1373–80.PubMedCrossRef Raftopoulos I, Awais O, Courcoulas AP, et al. Laparoscopic gastric bypass after antireflux surgery for the treatment of gastroesophageal reflux in morbidly obese patients: initial experience. Obes Surg. 2004;14:1373–80.PubMedCrossRef
9.
Zurück zum Zitat Perry Y, Courcoulas AP, Fernando HC, et al. Laparoscopic Roux-en-Y gastric bypass for recalcitrant gastroesophageal reflux disease in morbidly obese patients. JSLS. 2004;8:19–23.PubMed Perry Y, Courcoulas AP, Fernando HC, et al. Laparoscopic Roux-en-Y gastric bypass for recalcitrant gastroesophageal reflux disease in morbidly obese patients. JSLS. 2004;8:19–23.PubMed
10.
Zurück zum Zitat Flanagin BA, Mitchell MT, Thistlethwaite WA, et al. Diagnosis and treatment of atypical presentations of hiatal hernia following bariatric surgery. Obes Surg. 2010;20(3):386.PubMedCrossRef Flanagin BA, Mitchell MT, Thistlethwaite WA, et al. Diagnosis and treatment of atypical presentations of hiatal hernia following bariatric surgery. Obes Surg. 2010;20(3):386.PubMedCrossRef
11.
Zurück zum Zitat de Moura Almeida A, Cotrim HP, et al. Preoperative upper gastrointestinal endoscopy in obese patients undergoing bariatric surgery: is it necessary? Surg Obes Relat Dis. 2008;4:144–9.PubMedCrossRef de Moura Almeida A, Cotrim HP, et al. Preoperative upper gastrointestinal endoscopy in obese patients undergoing bariatric surgery: is it necessary? Surg Obes Relat Dis. 2008;4:144–9.PubMedCrossRef
12.
Zurück zum Zitat Loewen M, Giovanni J, Barba C. Screening endoscopy before bariatric surgery: a series of 448 patients. Surg Obes Relat Dis. 2008;4:709–12.PubMedCrossRef Loewen M, Giovanni J, Barba C. Screening endoscopy before bariatric surgery: a series of 448 patients. Surg Obes Relat Dis. 2008;4:709–12.PubMedCrossRef
13.
Zurück zum Zitat Muñoz R, Ibáñez L, Salinas J, et al. Importance of routine preoperative upper GI endoscopy: why all patients should be evaluated? Obes Surg. 2009;19:427–31.PubMedCrossRef Muñoz R, Ibáñez L, Salinas J, et al. Importance of routine preoperative upper GI endoscopy: why all patients should be evaluated? Obes Surg. 2009;19:427–31.PubMedCrossRef
14.
Zurück zum Zitat Kellogg TA, Andrade R, Maddaus M, et al. Anatomic findings and outcomes after antireflux procedures in morbidly obese patients undergoing laparoscopic conversion to Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007;3:52–7.PubMedCrossRef Kellogg TA, Andrade R, Maddaus M, et al. Anatomic findings and outcomes after antireflux procedures in morbidly obese patients undergoing laparoscopic conversion to Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007;3:52–7.PubMedCrossRef
15.
Zurück zum Zitat Fornari F, Gurski RR, Navarini D, et al. Clinical utility of endoscopy and barium swallow X-ray in the diagnosis of sliding hiatal hernia in morbidly obese patients: a study before and after gastric bypass. Obes Surg. 2010;20:702–8.PubMedCrossRef Fornari F, Gurski RR, Navarini D, et al. Clinical utility of endoscopy and barium swallow X-ray in the diagnosis of sliding hiatal hernia in morbidly obese patients: a study before and after gastric bypass. Obes Surg. 2010;20:702–8.PubMedCrossRef
16.
Zurück zum Zitat Gulkarov I, Wetterau M, Ren CJ, et al. Hiatal hernia repair at the initial laparoscopic adjustable gastric band operation reduces the need for reoperation. Surg Endosc. 2008;22:1035–41.PubMedCrossRef Gulkarov I, Wetterau M, Ren CJ, et al. Hiatal hernia repair at the initial laparoscopic adjustable gastric band operation reduces the need for reoperation. Surg Endosc. 2008;22:1035–41.PubMedCrossRef
17.
Zurück zum Zitat Soricelli E, Casella G, Rizzello M, et al. Initial experience with laparoscopic crural closure in the management of hiatal hernia in obese patients undergoing sleeve gastrectomy. Obes Surg. 2010;20:1149.PubMedCrossRef Soricelli E, Casella G, Rizzello M, et al. Initial experience with laparoscopic crural closure in the management of hiatal hernia in obese patients undergoing sleeve gastrectomy. Obes Surg. 2010;20:1149.PubMedCrossRef
18.
Zurück zum Zitat Merrouche M, Sabaté JM, Jouet P, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Obes Surg. 2007;17:894–900.PubMedCrossRef Merrouche M, Sabaté JM, Jouet P, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Obes Surg. 2007;17:894–900.PubMedCrossRef
19.
Zurück zum Zitat Tai CM, Lee YC, Wu MS, et al. The effect of Roux-en-Y gastric bypass on gastroesophageal reflux disease in morbidly obese Chinese patients. Obes Surg. 2009;19:565–70.PubMedCrossRef Tai CM, Lee YC, Wu MS, et al. The effect of Roux-en-Y gastric bypass on gastroesophageal reflux disease in morbidly obese Chinese patients. Obes Surg. 2009;19:565–70.PubMedCrossRef
20.
Zurück zum Zitat Approaching hiatal hernias during bariatric procedures: what to do? General Surgery News. 2009;36:3. Approaching hiatal hernias during bariatric procedures: what to do? General Surgery News. 2009;36:3.
21.
Zurück zum Zitat Caceres M, Eid GM, McCloskey CA. Recurrent paraesophageal hernia presenting as obstruction of roux limb after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2010;6:197.PubMedCrossRef Caceres M, Eid GM, McCloskey CA. Recurrent paraesophageal hernia presenting as obstruction of roux limb after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2010;6:197.PubMedCrossRef
22.
Zurück zum Zitat Chew CR, Jamieson GG, Devitt PG, et al. Prospective randomized trial of laparoscopic Nissen fundoplication with anterior versus posterior hiatal repair: late outcomes. World J Surg. 2011;35:2038–44.PubMedCrossRef Chew CR, Jamieson GG, Devitt PG, et al. Prospective randomized trial of laparoscopic Nissen fundoplication with anterior versus posterior hiatal repair: late outcomes. World J Surg. 2011;35:2038–44.PubMedCrossRef
23.
Zurück zum Zitat Reynoso JF, Goede MR, Tiwari MM, et al. Primary and revisional laparoscopic adjustable gastric band placement in patients with hiatal hernia. Surg Obes Relat Dis. 2011;7:290–4.PubMedCrossRef Reynoso JF, Goede MR, Tiwari MM, et al. Primary and revisional laparoscopic adjustable gastric band placement in patients with hiatal hernia. Surg Obes Relat Dis. 2011;7:290–4.PubMedCrossRef
24.
Zurück zum Zitat Lee YK, James E, Bochkarev V, et al. Long-term outcome of cruroplasty reinforcement with human acellular dermal matrix in large paraesophageal hiatal hernia. J Gastrointest Surg. 2008;12:811–5.PubMedCrossRef Lee YK, James E, Bochkarev V, et al. Long-term outcome of cruroplasty reinforcement with human acellular dermal matrix in large paraesophageal hiatal hernia. J Gastrointest Surg. 2008;12:811–5.PubMedCrossRef
25.
Zurück zum Zitat Oelschlager BK, Pellegrini CA, Hunter JG, et al. Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter, prospective, randomized trial. J Am Coll Surg. 2011;213:461–8.PubMedCrossRef Oelschlager BK, Pellegrini CA, Hunter JG, et al. Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter, prospective, randomized trial. J Am Coll Surg. 2011;213:461–8.PubMedCrossRef
Metadaten
Titel
Impact on Perioperative Outcomes of Concomitant Hiatal Hernia Repair with Laparoscopic Gastric Bypass
verfasst von
Vishal Kothari
Abhijit Shaligram
Jason Reynoso
Elizabeth Schmidt
Corrigan L. McBride
Dmitry Oleynikov
Publikationsdatum
01.10.2012
Verlag
Springer-Verlag
Erschienen in
Obesity Surgery / Ausgabe 10/2012
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-012-0714-0

Weitere Artikel der Ausgabe 10/2012

Obesity Surgery 10/2012 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.