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Background

Concurrent hiatal hernia repair (HHR) at the time of laparoscopic sleeve gastrectomy (LSG) has been proposed as a strategy to mitigate gastroesophageal reflux symptoms, however patient-reported outcomes are lacking.

Methods

Using a state-wide bariatric-specific data registry, all patients who underwent a primary LSG between 2015 and 2019 and who also answered a baseline and 1 year validated gastroesophageal reflux health related quality of life survey were identified (n=11,742). Reflux symptoms at 1 year as well as 30-day risk-adjusted adverse events were compared between patients who did and did not undergo concurrent HHR and stratified by technique (anterior vs posterior HHR).

Results

A total of 4,015 patients underwent a LSG-HHR. Compared to patients who underwent LSG alone, LSG-HHR patients were older (47.8 yrs vs. 44.7 yrs; p<0.0001), had a lower preoperative body mass index (46.0 kg/m2 vs. 47.8kg/m2; p<0.0001) and more likely to be female (85.2% vs 77.6%, p<0.0001). Patients who underwent a posterior HHR (n=3,205) experienced higher rates of symptom improvement (69.5% vs 64.0%, p=0.0014) and lower rates of new onset symptoms at 1 year (28.2% vs 30.2%, p=0.0500), with no statistically significant difference in complication rates. Patients who underwent an anterior HHR (n=496) experienced higher rates of hemorrhage (1.1% vs 0.8%, p=0.0066) and readmissions (2.2% vs 1.0%, p=0.012) with no significant difference in symptom improvement.

Conclusions

Concurrent hiatal hernia repair at the time of sleeve gastrectomy can improve reflux symptoms, however technique matters. Patients undergoing anterior repair derive no benefit and is a practice that should be abandoned.