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

Abstract

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.

Feasibility of Anti-reflux Gastric Bypass for Massive Paraesophageal Hernia in Obese Patients With Gastroesophageal Reflux Disease

“…In our study, the complication rate for ARGB was similar, but slightly higher, to that of standalone fundoplication, which is reported in the literature between 6% and 26% [13,22,23]. A recent study examining hiatal hernia repair and RYGB, but not massive hiatal hernias, found a complication rate of 26.3% within one year of surgery [17]. Perioperative outcomes for hiatal hernia repair with RYGB, such as overall morbidity, have been reported in the literature between 6.2% and 9.0% [24,25].…”

“…This finding is in comparison to a relatively high radiographic recurrence rate between 15% and 66% for standard PEH repair with fundoplication, although symptomatic recurrence is lower [13][14][15][16]. Other studies have examined recurrence in the setting of hiatal hernia repair and gastric bypass but not in the setting of massive hiatal hernias [17,18]. Our ability to detect recurrences is limited by the relatively short mean follow-up, and studies with longer follow-up and regular imaging will be needed to fully characterize the rate of recurrence in this population.…”

Brazilian Hernia and Abdominal Wall Society Statement on Large Hiatal Hernias Management

“…In morbidly obese patients, there is already consensus that a bariatric procedure should be added to the hernia correction. Roux-en-y gastric bypass is the recommended technique because it presents better results in treating reflux, with good weight loss, control of comorbidities, and reduction of LHH recurrences 43 .…”