Treatment of morbid obesity and gastroesophageal reflux with hiatal hernia by Lap-Band.
BACKGROUND
Esophageal reflux is common in obese patients. Hiatal hernia is considered a potential contraindication to placement of a Lap-Band.


METHODS
Esophageal investigation in patients who were candidates for a Lap-Band included clinical evaluation of symptoms (scoring system), endoscopic and radiologic evaluation, 24-h pH test, and stationary manometry. Patients with gastroesophageal reflux (GER) with or without hiatal hernia underwent the Lap-Band procedure.


RESULTS
GER was diagnosed in 12/40 morbidly obese patients, 11 of whom received a standard Lap-Band (3 patients were radiologically diagnosed with transient hiatal hernia). One patient with a large hiatal hernia underwent closure of the diaphragmatic esophageal hiatus, and the Lap-Band was positioned similarly to an Angelchik prosthesis. All but 1 patient who was lost at follow-up were symptom-free (range 1-24 months).


CONCLUSIONS
GER with or without hiatal hernia is not a contraindication for obese patients undergoing a Lap-Band procedure. It accomplishes by a single operation satisfactory treatment of these two disturbing diseases.
Angrisani
L
L
1st Department of Surgery, University Federico II, Medical School, Naples, Italy. lapclub.na@endosphere.it
Iovino
P
P
Lorenzo
M
M
Santoro
T
T
Sabbatini
F
F
Claar
E
E
Nicodemi
O
O
Persico
G
G
Tesauro
B
B
D000328:Adult; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D015391:Gastroplasty / Q000379:methods*; D006551:Hernia, Hiatal / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*