title: Sleeve gastrectomy and crural repair in obese patients with gastroesophageal reflux disease and/or hiatal hernia.
abstract: BACKGROUND
  Gastroesophageal reflux disease (GERD) with or without hiatal hernia (HH) is now recognized as an obesity-related co-morbidity. Roux-en-Y gastric bypass has been proved to be the most effective bariatric procedure for the treatment of morbidly obese patients with GERD and/or HH. In contrast, the indication for laparoscopic sleeve gastrectomy (SG) in these patients is still debated. Our objective was to report our experience with 97 patients who underwent SG and HH repair (HHR). The setting was a university hospital in Italy.
  
  
  METHODS
  From July 2009 to December 2011, 378 patients underwent a preoperative workup for SG. In 97 patients, SG was performed with HHR. The clinical outcome was evaluated considering GERD symptom resolution or improvement, interruption of antireflux medications, and radiographic evidence of HH recurrence.
  
  
  RESULTS
  Before surgery, symptomatic GERD was present in 60 patients (15.8%), and HH was diagnosed in 42 patients (11.1%). In 55 patients (14.5%), HH was diagnosed intraoperatively. The mean follow-up was 18 months. GERD remission occurred in 44 patients (73.3%). In the remaining 16 patients, antireflux medications were diminished, with complete control of symptoms in 5 patients. No HH recurrences developed. "De novo" GERD symptoms developed in 22.9% of the patients undergoing SG alone compared with 0% of patients undergoing SG plus HHR.
  
  
  CONCLUSIONS
  SG with HHR is feasible and safe, providing good management of GERD in obese patients with reflux symptoms. Small hiatal defects could be underdiagnosed at preoperative endoscopy and/or upper gastrointestinal contrast study. Thus, a careful examination of the crura is always recommended intraoperatively.
authors.affiliation: Surgical-Medical Department for Digestive Diseases, Policlinico Umberto I, University of Rome Sapienza, Rome, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Soricelli
authors.forename: Angelo
authors.initials: A
authors.lastname: Iossa
authors.forename: Giovanni
authors.initials: G
authors.lastname: Casella
authors.forename: Francesca
authors.initials: F
authors.lastname: Abbatini
authors.forename: Benedetto
authors.initials: B
authors.lastname: Calì
authors.forename: Nicola
authors.initials: N
authors.lastname: Basso
mesh_terms: D005240:Feasibility Studies; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D006551:Hernia, Hiatal / Q000150:complications / Q000601:surgery*; D006801:Humans; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D061646:Operative Time; D012008:Recurrence