Efficacy and Safety of Recurrent Paraesophageal Hernia Repair with Roux-en-Y Gastric Bypass

Roux-en-Y gastric bypass (RYGB) has been explored as a revisional option to failed paraesophageal hernia (PEH) repair with fundoplication, particularly in patients suffering from obesity. However, few studies have assessed long-term outcomes of RYGB with revisional PEH repairin regard to acid-suppre...

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Bibliographic Details
Published in:The American surgeon 2020-03, Vol.86 (3), p.250-255
Main Authors: Spann, Matthew D., Harrison, Noah J., English, Wayne J., Bolduc, Aaron R., Aher, Chetan V., Williams, D. Brandon, Hawkins, Alexander T.
Format: Article
Language:English
Subjects:
Acids
Adult
Body weight loss
Cohort Studies
Complications
Female
Foregut
Fundoplication - adverse effects
Fundoplication - methods
Gastric bypass
Gastric Bypass - methods
Gastroesophageal reflux
Gastrointestinal surgery
Hernia
Hernia, Hiatal - diagnosis
Hernia, Hiatal - surgery
Hernias
Herniorrhaphy - adverse effects
Herniorrhaphy - methods
Hospitals
Humans
Laparoscopy
Length of Stay
Male
Middle Aged
Obesity
Operative Time
Patient Safety
Patient satisfaction
Prognosis
Recurrence
Reoperation - methods
Retrospective Studies
Risk Assessment
Severity of Illness Index
Studies
Treatment Outcome
Vitamin deficiency
Weight control
Weight loss
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Summary:Roux-en-Y gastric bypass (RYGB) has been explored as a revisional option to failed paraesophageal hernia (PEH) repair with fundoplication, particularly in patients suffering from obesity. However, few studies have assessed long-term outcomes of RYGB with revisional PEH repairin regard to acid-suppressing medication use. We retrospectively identified 19 patients who underwent revisional PEH repair with RYGB between 2011 and 2018. The median operative time was 232 minutes with a median hospital length of stay of two days. The median length of follow-up was 24 months. Two patients (10.5%) had complications in the first 30 days, and five patients (26.3%) had complications within one year. Of the 12 patients on preoperative acid suppression, 6 (50%) were either off medication or on reduced dose at 12 months. The median BMI decrease was 14.4 kg/m2 at 12 months and did not change significantly afterward. Although rates of acid-suppression medication use did not change overall after revisional PEH repair with RYGB, patients experienced successful long-term management of morbid obesity and sustained weight loss. Revisional PEH repair with RYGB is a safe and effective option, with a complication rate comparable with the reported rates after revisional foregut procedures such as revisional Nissen fundoplication.
ISSN:0003-1348
1555-9823
DOI:10.1177/000313482008600336