title: Concurrent Large Para-oesophageal Hiatal Hernia Repair and Laparoscopic Adjustable Gastric Banding: Results from 5-year Follow Up.
abstract: OBJECTIVE
  The objective of the study is to identify the efficacy and safety of combining laparoscopic adjustable gastric banding with repair of large para-oesophageal hernias.
  
  
  BACKGROUND
  Para-oesophageal hernias are more common in the obese with higher recurrence rates following repair. The effect and safety of combining para-oesophageal hernia repair with laparoscopic adjustable gastric banding is unknown.
  
  
  METHODS
  One-hundred fourteen consecutive patients undergoing primary laparoscopic adjustable gastric banding with concurrent repair of a large para-oesophageal hernia were prospectively identified and matched to a control group undergoing primary laparoscopic adjustable gastric banding only. Weight loss and complication data were retrieved from a prospectively maintained database, and a standardised bariatric outcome questionnaire was used to assess post-operative symptoms, satisfaction with surgery and satiety scores.
  
  
  RESULTS
  At a mean follow up of 4.9 ± 2.1 years, total weight loss was 16.4 ± 9.9% in the hernia repair group and 17.6 ± 12.6% in the control group (p = 0.949), with 17 vs. 11% loss to follow up rates (p = 0.246). No statistically significant difference in revisional surgery rate and symptomatic recurrence of hiatal hernia was documented in four patients in the hernia repair group (3.5%). No statistically significant difference in mean reflux (9.9 vs. 10.3, p = 0.821), dysphagia (20.7 vs. 20.1, p = 0.630) or satiety scores was identified.
  
  
  CONCLUSIONS
  Concurrent repair of large para-oesophageal hiatal hernia and laparoscopic adjustable gastric banding placement is safe and effective both in terms of symptom control and weight loss over the intermediate term. In obese patients with large hiatal hernias, consideration should be given to combining repair of the hernia with a bariatric procedure.
authors.affiliation: Centre for Obesity Research and Education, Monash University, Melbourne, 3004, Australia. ajlon1@student.monash.edu.au.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Long
authors.affiliation: Centre for Obesity Research and Education, Monash University, Melbourne, 3004, Australia.|Monash University, Department of Surgery, The Alfred Hospital, 99 Commercial Rd, Melbourne, 3004, Australia.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Burton
authors.affiliation: Centre for Obesity Research and Education, Monash University, Melbourne, 3004, Australia.
authors.forename: Cheryl P
authors.initials: CP
authors.lastname: Laurie
authors.affiliation: Centre for Obesity Research and Education, Monash University, Melbourne, 3004, Australia.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Anderson
authors.affiliation: Melbourne University, Department of Gastroenterology, Royal Melbourne Hospital, 300 Grattan St, Parkville, 3050, Australia.
authors.forename: Geoff S
authors.initials: GS
authors.lastname: Hebbard
authors.affiliation: Centre for Obesity Research and Education, Monash University, Melbourne, 3004, Australia.
authors.forename: Paul E
authors.initials: PE
authors.lastname: O'Brien
authors.affiliation: Centre for Obesity Research and Education, Monash University, Melbourne, 3004, Australia.|Monash University, Department of Surgery, The Alfred Hospital, 99 Commercial Rd, Melbourne, 3004, Australia.
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty; D006551:Hernia, Hiatal / Q000150:complications / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery*; D055815:Young Adult
keywords: Bariatric surgery; Laparoscopic adjustable gastric banding; Obesity; Para-oesophageal hiatal hernia; Reflux