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Obesity Week 2013

LSG in combination with HH repair yields positive outcomes

Higher %EWL in patients undergoing either LSG+HH or LSG+PEH, compared to laparoscopic sleeve gastrectomy alone

Patients who undergo laparoscopic sleeve gastrectomy in combination with a hiatal hernia (HH) repair have improvement in gastro-oesophageal reflux disease (GERD) symptoms and reported a high post-operative satisfaction rate, according to researchers at St Luke's University Hospital and Health Network, Bethlehem, PA.

The study entitled, ‘Outcome of laparoscopic sleeve gastrectomy performed in combination with hiatal hernia repair: single center experience’, evaluated the incidence and the type of HH repair during laparoscopic sleeve gastrectomy and to investigate the effect of HH repair on GERD and weight loss following surgery.

The researchers performed a retrospective review of prospectively collected data on all patients who underwent a primary laparoscopic sleeve gastrectomy between September 2009 and December 2012. Patients with Type I HH underwent an anterior hernia repair (LSG+HH) whereas patients with Type II, III and IV HH (para-oesophageal hernias) underwent a formal posterior repair with or without a synthetic absorbable mesh (LSG+PEH). Patient demographics included age, gender, race, BMI and preoperative %EWL.

The primary outcomes included operative time, blood loss and postoperative excess weight loss at three, six and 12 months. In addition, GERD Health Related Quality of Life (HRQL) questionnaire was given to all patients postoperatively.

To analyse the questions they conducted separate, mixed randomised-repeated measures of analyses of variance (ANOVA) with hernia repair as the randomised factor, and time between pre- and post-operative outcome as the repeated factor.

The outcomes revealed that 338 patients underwent primary laparoscopic sleeve gastrectomy and included in the analysis. Among those patients 99 patients (29%) were found to have a HH: 56 patients (16%) had a Type I HH and underwent LSG in combination with anterior repair of HH (LSH+HH).

An additional 43 patients (13%) were found to have para-oesophageal hernias and underwent LSG+PEH. Among the 43 patients who underwent LS+PEH, 22 patients underwent LS+PEH with absorbable mesh placement.

After six and 12 months, they reported a higher %EWL in patients undergoing either LSG+HH or LSG+PEH, compared to laparoscopic sleeve gastrectomy alone. The results also revealed a statistically significant improvement in GERD symptoms postoperatively for both hernia repair groups based on the GERD (HRQL).

Finally, patients who underwent laparoscopic sleeve gastrectomy+HH and laparoscopic sleeve gastrectomy +PEH reported a higher satisfaction rate with their postoperative condition compared to patients who underwent a laparoscopic sleeve gastrectomy alone (93% vs. 87%).

“To our knowledge, this is the largest series of laparoscopic sleeve gastrectomy performed in combination with HH repair. Also, the excess weight loss is comparable to patients undergoing laparoscopic sleeve gastrectomy alone,” the researchers concluded. “Further studies are needed to clarify the long term outcome of patients undergoing laparoscopic sleeve gastrectomy in combination with hiatal hernia repair.”

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