Paraesophageal hernia repair with partial longitudinal gastrectomy in obese patients

Matthew Davis, John Rodriguez, Kevin El-Hayek, Stacy Brethauer, Philip Schauer, Andrea Zelisko, Bipan Chand, Colin O’Rourke, Matthew Kroh

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background and Objectives: Treatment of gastroesophageal reflux disease (GERD) with hiatal hernia in obese patients has proven difficult, as studies demonstrate poor symptom control and high failure rates in this patient population. Recent data have shown that incorporating weight loss procedures into the treatment of reflux may improve overall outcomes. Methods: We retrospectively reviewed 28 obese and morbidly obese patients who presented from December 2007 through July 2013 with large or recurrent type 3 or 4 paraesophageal hernia. All of the patients underwent combined paraesophageal hernia repair and partial longitudinal gastrectomy. Charts were retrospectively reviewed, and the patients were contacted to determine symptomatic relief. Results: Mean preoperative body mass index was 38.1 ± 4.9 kg/m2. Anatomic failure of prior fundoplication occurred in 7 patients (25%). The remaining 21 had primary paraesophageal hernia, 3 of which were type 4. Postoperative complications included pulmonary embolism (n = 1), pulmonary decompensation (n = 2), and wound infection (n = 1). Mean hospital stay was 5 ± 3 days. Upper gastrointestinal esophagogram was performed in 21 patients with no immediate recurrence or staple line dehiscence. Mean excess weight loss was 44 ± 25%. All of the patients surveyed experienced near to total resolution of their preoperative symptoms within the first month. At 1 year, symptom scores decreased significantly. At 27 months, however, there was a mild increase in the scores. Return of severe symptoms occurred in 2 patients, both of whom underwent conversion to gastric bypass. Conclusions: Combined laparoscopic paraesophageal hernia repair with longitudinal partial gastrectomy offers a safe, feasible approach to the management of large or recurrent paraesophageal hernia in well-selected obese and morbidly obese patients. Short-term results were promising; however, intermediate results showed increasing rates of reflux symptoms that required medical therapy or conversion to gastric bypass.

Original languageEnglish (US)
Article numbere2015.00060
JournalJournal of the Society of Laparoendoscopic Surgeons
Volume19
Issue number3
DOIs
StatePublished - Jul 1 2015

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Hiatal Hernia
Herniorrhaphy
Gastrectomy
Gastric Bypass
Weight Loss
Fundoplication
Wound Infection
Gastroesophageal Reflux
Pulmonary Embolism
Length of Stay
Body Mass Index
Therapeutics
Recurrence
Lung

All Science Journal Classification (ASJC) codes

  • Surgery

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Paraesophageal hernia repair with partial longitudinal gastrectomy in obese patients. / Davis, Matthew; Rodriguez, John; El-Hayek, Kevin; Brethauer, Stacy; Schauer, Philip; Zelisko, Andrea; Chand, Bipan; O’Rourke, Colin; Kroh, Matthew.

In: Journal of the Society of Laparoendoscopic Surgeons, Vol. 19, No. 3, e2015.00060, 01.07.2015.

Research output: Contribution to journalArticle

Davis, M, Rodriguez, J, El-Hayek, K, Brethauer, S, Schauer, P, Zelisko, A, Chand, B, O’Rourke, C & Kroh, M 2015, 'Paraesophageal hernia repair with partial longitudinal gastrectomy in obese patients', Journal of the Society of Laparoendoscopic Surgeons, vol. 19, no. 3, e2015.00060. https://doi.org/10.4293/JSLS.2015.00060
Davis, Matthew ; Rodriguez, John ; El-Hayek, Kevin ; Brethauer, Stacy ; Schauer, Philip ; Zelisko, Andrea ; Chand, Bipan ; O’Rourke, Colin ; Kroh, Matthew. / Paraesophageal hernia repair with partial longitudinal gastrectomy in obese patients. In: Journal of the Society of Laparoendoscopic Surgeons. 2015 ; Vol. 19, No. 3.
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