Paraesophageal Hernia Repair With Partial Longitudinal Gastrectomy in Obese Patients.
OBJECTIVE
Treatment of gastroesophageal reflux disease (GERD) with hiatal hernia in obese patients has proven difficult, as studies demonstrate poor symptom control and high failure rates in this patient population. Recent data have shown that incorporating weight loss procedures into the treatment of reflux may improve overall outcomes.


METHODS
We retrospectively reviewed 28 obese and morbidly obese patients who presented from December 2007 through July 2013 with large or recurrent type 3 or 4 paraesophageal hernia. All of the patients underwent combined paraesophageal hernia repair and partial longitudinal gastrectomy. Charts were retrospectively reviewed, and the patients were contacted to determine symptomatic relief.


RESULTS
Mean preoperative body mass index was 38.1 ± 4.9 kg/m(2). Anatomic failure of prior fundoplication occurred in 7 patients (25%). The remaining 21 had primary paraesophageal hernia, 3 of which were type 4. Postoperative complications included pulmonary embolism (n = 1), pulmonary decompensation (n = 2), and wound infection (n = 1). Mean hospital stay was 5 ± 3 days. Upper gastrointestinal esophagogram was performed in 21 patients with no immediate recurrence or staple line dehiscence. Mean excess weight loss was 44 ± 25%. All of the patients surveyed experienced near to total resolution of their preoperative symptoms within the first month. At 1 year, symptom scores decreased significantly. At 27 months, however, there was a mild increase in the scores. Return of severe symptoms occurred in 2 patients, both of whom underwent conversion to gastric bypass.


CONCLUSIONS
Combined laparoscopic paraesophageal hernia repair with longitudinal partial gastrectomy offers a safe, feasible approach to the management of large or recurrent paraesophageal hernia in well-selected obese and morbidly obese patients. Short-term results were promising; however, intermediate results showed increasing rates of reflux symptoms that required medical therapy or conversion to gastric bypass.
Department of Surgery, Digestive Disease Institute.
Matthew
M
Davis
Department of Surgery, Digestive Disease Institute.
John
J
Rodriguez
Department of Surgery, Digestive Disease Institute.
Kevin
K
El-Hayek
Department of Surgery, Bariatric and Metabolic Institute.
Stacy
S
Brethauer
Department of Surgery, Bariatric and Metabolic Institute.
Philip
P
Schauer
Department of General Surgery, Akron General Medical Center, Akron, Ohio.
Andrea
A
Zelisko
Division of GI/Minimally Invasive Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois.
Bipan
B
Chand
Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
Colin
C
O'Rourke
Department of Surgery, Digestive Disease Institute.
Matthew
M
Kroh
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006551:Hernia, Hiatal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
GERD; Obesity; Paraesophageal hernia; Sleeve gastrectomy