title: Initial experience with laparoscopic crural closure in the management of hiatal hernia in obese patients undergoing sleeve gastrectomy.
abstract: BACKGROUND
  The prevalence of gastroesophageal reflux disease (GERD) and/or hiatal hernia (HH) is significantly increased in morbidly obese patients. Laparoscopic bariatric procedures such as gastric banding (LGB) and Roux-en-Y gastric bypass have been shown to improve both obesity and reflux symptoms. The aim of this paper is to evaluate the effectiveness of laparoscopic sleeve gastrectomy (LSG) and hiatal hernia repair (HHR) for the treatment of obesity complicated by HH.
  
  
  METHODS
  From October 2008, six patients underwent HHR in addition to LSG. Clinical outcomes have been evaluated in terms of GERD symptoms improvement or resolution, interruption of antireflux medication, and X-ray evidence of HH recurrence.
  
  
  RESULTS
  Symptomatic HH was diagnosed preoperatively in four patients. In two additional patients, HH was asymptomatic and it was diagnosed intraoperatively. Prosthetic reinforcement of crural closure was performed in two symptomatic cases with a HH >5 cm. Mortality was nil and no complications occurred. After a mean follow-up of 4 months, GERD symptoms resolution occurred in three patients, while the other patient reported an improvement of reflux. Body mass index had fallen from 43.4 to 36.2 kg/m(2). A small recurrence in the patient with persistence of reflux symptoms has been radiologically reported.
  
  
  CONCLUSIONS
  Laparoscopic crural closure in addition to LSG could represent a valuable option for the synchronous management of morbid obesity and HH, providing good outcomes in terms of weight loss and GERD symptoms control.
authors.affiliation: Surgical-Medical Department for Digestive Diseases, Policlinico Umberto I, University Sapienza, Viale del Policlinico, 00161, Rome, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Soricelli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Casella
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzello
authors.forename: Benedetto
authors.initials: B
authors.lastname: Calì
authors.forename: Giorgio
authors.initials: G
authors.lastname: Alessandri
authors.forename: Nicola
authors.initials: N
authors.lastname: Basso
mesh_terms: D000328:Adult; D005260:Female; D005743:Gastrectomy; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000601:surgery*; D006551:Hernia, Hiatal / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery*; D016896:Treatment Outcome; D015431:Weight Loss