title: Crural repair permits morbidly obese patients with not large hiatal hernia to choose laparoscopic adjustable banding as a bariatric surgical treatment.
abstract: BACKGROUND
  Hiatal hernia, present radiologically in about 50% of patients desiring bariatric surgery, has been thought a contraindication to laparoscopic adjustable gastric banding (LAGB). Posited was the notion that adding crural repair to LAGB would enable this procedure to be offered to patients desiring bariatric surgery who had hiatal hernias.
  
  
  METHODS
  After obtaining IRB approval, charts of all patients who underwent simultaneous crural repair and LAGB from June 2003 to January 2006 were reviewed. All patients were evaluated with the DeMeester score and the GERD-HQRL score pre- and postoperatively. Statistical analyses included the Mann-Whitney U test and the Chi-squared test.
  
  
  RESULTS
  Twenty-one patients underwent laparoscopic procedure with crural repair; none required conversion to an open procedure. There were no mortalities. Two complications, a wound infection at the level of the port, and a case postoperative dysphagia resolved with therapy. Eighty-six percent of the patients ceased regular intake of heartburn medicines, P<.01. Median percent excess weight loss was 45% at 1 year and 55% at 2 years. The modified DeMeester score fell to 0-2 postoperatively (P<.01). Two years after the procedure, symptoms were less, as assessed by GERD-HQRL scores (P<.01).
  
  
  CONCLUSIONS
  Crural repair permits LAGB to be safely and effectively performed in patients with hiatal hernia.
authors.affiliation: Division of General Surgery, Department of Surgery, Texas Tech University Health Sciences Center, 3601 4th Street, MS 8312, Lubbock, TX 79430, USA. eldo.frezza@ttuhsc.edu
authors.forename: Eldo E
authors.initials: EE
authors.lastname: Frezza
authors.forename: Audrae
authors.initials: A
authors.lastname: Barton
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Wachtel
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D000075202:Contraindications; D005260:Female; D015391:Gastroplasty; D006551:Hernia, Hiatal / Q000453:epidemiology*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology* / Q000601:surgery