Laparoscopic Roux-en-Y gastric bypass for treatment of symptomatic paraesophageal hernia in the morbidly obese: medium-term results.
BACKGROUND
The ideal surgical approach for treatment of symptomatic paraesophageal hernias (PEH) in obese patients remains elusive. The objective of this study was to assess the safety, feasibility, and effectiveness of combined laparoscopic PEH repair and Roux-en-Y gastric bypass (RYGB) for the management of symptomatic PEH in morbidly obese patients.


METHODS
Fourteen patients with symptomatic PEH and morbid obesity (body mass index [BMI]>35 kg/m(2)) underwent laparoscopic PEH repair with RYGB between 2008 and 2011. Demographic characteristics and preoperative and perioperative details were analyzed. Patients were contacted in October 2013 for follow-up. BMI, reflux symptoms, and disease-specific quality of life (QoL) data were obtained.


RESULTS
There were 11 females (79%). Median age and preoperative BMI were 48 years and 42 kg/m(2), respectively. Mean operative time was 180 minutes, with median length-of-stay of 4 days. There were no perioperative deaths, and 5 patients experienced postoperative complications including 1 gastrojejunostomy leak. Complete follow-up with a median follow-up interval of 35 months was available in 9 (64%) patients. The median % excess weight loss was 67.9%. Thirty-three percent required antisecretory medications for reflux control, compared to 89% preoperatively. Seventy-eight percent of patients reported good to excellent QoL outcomes assessed by the Gastroesophageal Reflux Disease Health-Related Quality of Life questionnaire. Overall, 89% of patients were satisfied with their operation and would undergo the procedure again.


CONCLUSIONS
Combined laparoscopic PEH repair and RYGB is a safe, feasible, and effective treatment option for morbidly obese patients with symptomatic PEH, and offers good to excellent disease-specific quality-of-life outcomes at medium-term follow-up. To date, this is the largest series with the longest follow-up in this unique patient population.
Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Umer I
UI
Chaudhry
Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Brendan M
BM
Marr
Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Sylvester N
SN
Osayi
Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Dean J
DJ
Mikami
Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Bradley J
BJ
Needleman
Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
W Scott
WS
Melvin
Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio. Electronic address: kyle.perry@osumc.edu.
Kyle A
KA
Perry
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D006551:Hernia, Hiatal / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D061646:Operative Time; D061214:Patient Safety; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
Laparoscopy; Morbid obesity; Paraesophageal hernia; Roux-en-Y gastric bypass