title: Impact of Bariatric Surgery on Hiatal Hernia Repair Outcomes.
abstract: Large hiatal hernias are notorious for their high recurrence rates after conventional repair. Recurrence rates have been described to be higher in obese patients due to increased intra-abdominal pressure. We hypothesized that patients who undergo hiatal hernia repair (HHR) with bariatric surgery (BAR) will have a lower hernia recurrence rate when compared to patients who undergo HHR with fundoplication (FP) due to the decrease in intra-abdominal pressure observed with weight loss. This was an Institutional Review Board approved retrospective review. The outcomes of patients who underwent HHR+BAR as well as patients who had HHR+FP only from 2007 to 2014 were reviewed. Patients who had small hiatal hernias (<2 cm), underwent an anterior repair, or had gastropexy only were excluded. The primary outcome was hernia recurrence and reflux resolution. The outcomes of 58 patients who had HHR+BAR were compared with 30 patients with HHR+FP. Hernia recurrence rate for HHR+BAR was 12 per cent, whereas hernia recurrence rate for HHR+FP was 38 per cent (P < 0.01). Reflux resolution for HHR+FP was 78 per cent, whereas reflux improvement rate for HHR+BAR was 84 per cent (P = n.s.). Combining HHR with BAR leads to a lower hernia recurrence rate when compared to patients who undergo HHR with FP.
authors.affiliation: Division of Bariatric Surgery, Department of Surgery, Carolinas Healthcare System, Charlotte, North Carolina, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Sutherland
authors.forename: Timothy
authors.initials: T
authors.lastname: Kuwada
authors.forename: Keith
authors.initials: K
authors.lastname: Gersin
authors.forename: Connie
authors.initials: C
authors.lastname: Simms
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Stefanidis
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D005260:Female; D018662:Fundoplication; D006551:Hernia, Hiatal / Q000150:complications* / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome