title: Concomitant hiatal hernia repair with laparoscopic sleeve gastrectomy is safe: analysis of the ACS-NSQIP database.
abstract: BACKGROUND
  Gastroesophageal acid reflux disease (GERD) is prevalent after laparoscopic sleeve gastrectomy (LSG), a common bariatric surgical procedure worldwide. Some studies have suggested that concomitant hiatal hernia repair (HHR) during LSG reduces the risk of GERD, but this has not been substantiated. Little is known about the safety of adding an HHR in this setting. The present study aims to compare 30-day morbidity and mortality and length of hospital stay between patients undergoing LSG alone and those undergoing LSG with HHR.
  
  
  METHODS
  A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database was performed to identify patients who underwent LSG procedures alone or with concomitant HHR between 2010 and 2014. Univariate and multivariate analyses of 30-day morbidity and mortality and length of hospital stay were performed.
  
  
  RESULTS
  Between 2010 and 2014, 32,581 patients underwent LSG. Of those, 4687 (14.4%) underwent concomitant HHR. No significant differences in 30-day mortality; overall morbidity; reoperation; sepsis; and wound, cardiac, respiratory, and renal complications were found between the 2 study groups on univariate and multivariate analyses. Length of hospital stay, risk of thromboembolic events, and blood transfusions were lower in the LSG+HHR group, even on multivariate analysis.
  
  
  CONCLUSIONS
  Concomitant HHR at the time of LSG is not associated with increased risk of 30-day mortality or major morbidity. However, the effectiveness of this additional procedure should be assessed using long-term data on the resolution of GERD symptoms after LSG.
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Hanaa N
authors.initials: HN
authors.lastname: Dakour Aridi
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Clinical Research Institute, Biostatistics Unit, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Hani
authors.initials: H
authors.lastname: Tamim
authors.affiliation: Clinical Research Institute, Biostatistics Unit, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Aurelie
authors.initials: A
authors.lastname: Mailhac
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: bs21@aub.edu.lb.
authors.forename: Bassem Y
authors.initials: BY
authors.lastname: Safadi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000379:methods; D005743:Gastrectomy / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery; D006551:Hernia, Hiatal / Q000150:complications / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery; D061214:Patient Safety; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bariatric surgery; Gastroesophageal reflux disease; Hiatal hernia; NSQIP; Obesity; Sleeve gastrectomy