Outcomes of Bariatric Surgery With Concomitant Hiatal Hernia Repair Using an Absorbable Tissue Matrix

• Published in: The American surgeon 2023-02, Vol.89 (2), p.293-299
• Main Authors: Love, Michael W., Verna, Daniel F., Kothari, Shanu N., Scott, John D.
• Format: Article
• Language: English
• Subjects: Bariatric Surgery; Body mass index; Chronic obstructive pulmonary disease; Demographics; Endoscopy; Esophagus; Gastrectomy; Gastrectomy - methods; Gastric Bypass; Gastroesophageal reflux; Gastrointestinal surgery; Health care facilities; Hernia; Hernia, Hiatal - complications; Hernia, Hiatal - surgery; Herniorrhaphy - methods; Hiatal hernias; Humans; Laparoscopy - methods; Patients; Proton pump inhibitors; Reinforcement; Retrospective Studies; Sleeves; Surgery; Sutures; Treatment Outcome
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/00031348211023450

Background Hiatal hernias are a common finding in patients who undergo bariatric surgery with an incidence of about 20% of all bariatric patients. Controversy exists on the utility of a biosynthetic tissue matrix (BTM) usage in combination with crural repair. This study was designed to explore the safety and benefits of the use of a BTM during concomitant hiatal hernia repair with bariatric surgical procedures. Methods This was a retrospective chart review of bariatric surgical patients who underwent a concomitant hiatal hernia repair at a single practice at a tertiary academic medical center from January 2014 to February 2019. Results A total of 420 patients were reviewed. Hiatal BTM reinforcement, recurrence, and postoperative proton pump inhibitor use were reported by type of operation. Recurrence was higher in gastric bypass patients who underwent hiatal hernia repair with suture cruroplasty alone vs. those who also underwent hiatal BTM reinforcement (7.1% vs. 3.7%, P = .52) and significantly higher in gastric sleeve patients who underwent hiatal hernia repair with suture cruroplasty alone vs. those who also underwent hiatal BTM reinforcement (7.1% vs. .5%, P = .01). No patient required reoperation for hiatal hernia recurrence. Discussion Performing Roux-en-Y gastric bypass or vertical sleeve gastrectomy with concomitant hiatal hernia repair is safe and durable. Employing crural reinforcement with BTM may be of benefit in reducing recurrence rates of hiatal hernia, particularly in sleeve gastrectomy patients.