title: Impact of concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair on gastro-oesophageal reflux disease in morbidly obese patients.
abstract: BACKGROUND
  The aim of this study was to analyse the impact of hiatal hernia repair (HHR) on gastro-oesophageal reflux disease (GERD) in morbidly obese patients with hiatus hernia undergoing laparoscopic sleeve gastrectomy (LSG).
  
  
  METHODS
  It is a retrospective study involving ten morbidly obese patients with large hiatus hernia diagnosed on pre-operative endoscopy who underwent LSG and simultaneous HHR. The patients were assessed for symptoms of GERD using a Severity symptom score (SS) questionnaire and anti-reflux medications.
  
  
  RESULTS
  Of the ten patients, five patients had GERD preoperatively. At the mean follow-up of 11.70 ± 6.07 months after surgery, four patients (80%) showed complete resolution while one patient complained of persistence of symptoms. Endoscopy in this patient revealed resolution of esophagitis indicating that the persistent symptoms were not attributable to reflux. The other five patients without GERD remained free of any symptom attributable to GERD. Thus, in all ten patients, repair of hiatal hernia (HH) during LSG led to either resolution of GERD or prevented any new onset symptom related to GER.
  
  
  CONCLUSIONS
  In morbidly obese patients with HH with or without GERD undergoing LSG, repair of the hiatus hernia helps in amelioration of GERD and prevents any new onset GER. Thus, the presence of HH should not be considered as a contraindication for LSG.
authors.affiliation: Department of Surgical Disciplines, All Institute of Medical Sciences, New Delhi, India.
authors.forename: Harshit
authors.initials: H
authors.lastname: Garg
authors.affiliation: Department of Surgical Disciplines, All Institute of Medical Sciences, New Delhi, India.
authors.forename: Balasubiramaniyan
authors.initials: B
authors.lastname: Vigneshwaran
authors.affiliation: Department of Surgical Disciplines, All Institute of Medical Sciences, New Delhi, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Aggarwal
authors.affiliation: Department of Gastroenterology, All Institute of Medical Sciences, New Delhi, India.
authors.forename: Vineet
authors.initials: V
authors.lastname: Ahuja