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SAGES 2013

Standardised approach for HH repair not necessary

Location and number of sutures has no affect readmission or reoperation

There is no need to standardise the technical aspects of hiatal hernia repair (HHR) during laparoscopic adjustable gastric banding, according to a study by researchers from New York University Medical Center. They claim that the number or location of sutures does not impact band-related reoperation, postoperative weight loss or 30-day readmission. However, patients with fewer or anterior sutures did have shorter procedure times.

Although it has been well documented that simultaneous hiatal hernia repair during laparoscopic adjustable gastric banding  decreases the rate of reoperation, it is not known whether the number of sutures and location of suture placement (anterior hiatus, posterior hiatus, or both) impact on outcomes and whether establishing a standardised approach would reduce reoperation rates for band-related problems.

The researchers conducted a retrospective analysis of 2,301 patients undergoing laparoscopic adjustable gastric banding with hiatal hernia repair from 2007 to 2011.

The band was performed with a standard pars flaccida technique and the hiatal hernia repair with simple, interrupted Prolene sutures, with the number and location of suture placement left to the judgment of the surgeon.

In addition to recording the number and location of sutures, the investigators also noted demographics, procedure time, length of stay, follow-up time, postoperative BMI and %EWL at yearly intervals, and rates of readmission and reoperation.

Results

The majority of patients had one suture (55%, n =1,282; 2 sutures =784, 3 sutures =188, 4+ sutures =47; range = 1-6). The researchers reported that there was no difference in length of follow-up, with 91-97% follow-up at one year, and 66-77% at four years.

Patients with fewer sutures had a significantly significant shorter procedure time (one suture 45 minutes vs. 4+ sutures 56 minutes, p<0.0001), whereas length of stay, 30-day readmission, band-related reoperation, and postop BMI and %EWL were not statistically significant.

The location of suture placement was known in 2,246 (98%) of the patients, with the majority of patients having anterior sutures (61%, n = 1,378; posterior = 735, both = 133). OR time was shorter in those with anterior suture (41 min. vs. posterior 56 minutes vs. both 59 minutes, p<0.0001). Patients with posterior suture had a longer length of stay (84% one day vs. anterior 74% one day vs. both 74% one day, p=0.0001). There was no difference in 30-day readmission, band-related reoperation, and postop BMI and %EWL.

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