Get ASMBS 2022 OnDemand Now! Learn More about OnDemand

Background

Patients undergoing laparoscopic sleeve gastrectomy (LSG) are frequently diagnosed with hiatal hernia (HH).Objectives: To prospectively compare perioperative outcomes in patients undergoing LSG with and without HH repair (HHR).

Methods

As part of randomized trial NCT04168060 evaluating the role of routine crural dissection during LSG, we analyzed data for an initial cohort of patients undergoing LSG with and without HHR. At time of surgery, patients with anteriorly visible HH underwent primary HHR followed by LSG. All others were randomized to standalone LSG vs complete crural dissection with HHR if HH was identified, followed by LSG. Medication records were queried and validated questionnaires assessing pain, nausea/vomiting, reflux, and dysphagia were collected in the immediate postoperative period and at regular follow-up.

Results

Between November 2019 and June 2020, 98 patients (71 female) were enrolled. We diagnosed 44 patients with HH, including 35 visible anteriorly and another 9 in the 27 patients randomized to crural dissection. Compared to those without, patients with HH were significantly older and more likely to be Black. There were no differences in preoperative rates of gastroesophageal reflux disease or GerdQ and BEDQ scores. Operative time was prolonged in the HHR+LSG group, but median length of stay was similar. Analgesic and antiemetic use were similar and there were no differences in median scores assessing pain, nausea/vomiting, reflux, and dysphagia up to 6 months follow-up.

Conclusions

In this randomized, prospective study, concurrent HHR during LSG increased operative time but was not associated with additional morbidity up to 6 months.