Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Apr-Jun;15(2):188-92.
doi: 10.4293/108680811X13022985132164.

Combined treatment of symptomatic massive paraesophageal hernia in the morbidly obese

George Kasotakis  1 , Sumeet K Mittal, Ranjan Sudan
Affiliations

Combined treatment of symptomatic massive paraesophageal hernia in the morbidly obese

George Kasotakis et al. JSLS. 2011 Apr-Jun.

Abstract

Introduction: Repair of large paraesophageal hernias by itself is associated with high failure rates in the morbidly obese. A surgical approach addressing both giant paraesophageal hernia and morbid obesity has, to our knowledge, not been explored in the surgical literature.

Methods: A retrospective review of a bariatric surgery database identified patients who underwent simultaneous repair of large type 3 paraesophageal hernias with primary crus closure and Roux-en-Y gastric bypass (RYGB). Operative time, intraoperative and 30-day morbidity, weight loss, resolution of comorbid conditions and use of antireflux medication were outcome measures. Integrity of crural closure was studied with a barium swallow.

Results: Three patients with a mean body mass index of 46kg/m(2) and mean age of 46 years underwent repair of a large paraesophageal hernia, primary crus closure, and RYGB. Mean operative time was 241 minutes and length of stay was 4 days. There was no intraoperative or 30-day morbidity. One patient required endoscopic balloon dilatation of the gastrojejunostomy. At 12 months, all patients were asymptomatic with excellent weight loss and resolution of comorbidities. Contrast studies showed no recurrence of the hiatal hernia.

Conclusion: Simultaneous laparoscopic repair of large paraesophageal hernias in the morbidly obese is safe and effective.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
CT scan demonstrating large intrathoracic stomach due to paraesophageal hernia type III.
Figure 2.
Figure 2.
Chest x-ray demonstrating intrathoracic stomach.
Figure 3.
Figure 3.
Postoperative barium swallow at one-year following hiatal hernia repair and Roux-en-Y gastric bypass.
See this image and copyright information in PMC

References

    1. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006;295:1549–1555 - PubMed
    1. Buchwald H, Cowan GSM, Pories WJ. eds. Surgical Management of Obesity. Saunders Elsevier; 2006
    1. El-Serag HB, Graham DY, Satia JA, Rabeneck L. Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol. 2005;100:1243–1250 - PubMed
    1. Nocon M, Labenz J, Willich SN. Lifestyle factors and symptoms of gastro-oesophageal reflux – a population-based study. Aliment Pharmacol Ther. 2006;23:169–174 - PubMed
    1. El-Serag HB. Time trends of gastroesophageal reflux disease: a systematic review. Clin Gastroenterol Hepatol. 2007;5:17–26 - PubMed