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. 2021 Jan;17(1):72-80.
doi: 10.1016/j.soard.2020.08.035. Epub 2020 Sep 3.

Concurrent hiatal hernia repair and bariatric surgery: outcomes after sleeve gastrectomy and Roux-en-Y gastric bypass

Kristina H Lewis  1 , Katherine Callaway  2 , Stephanie Argetsinger  2 , Jamie Wallace  2 , David E Arterburn  3 , Fang Zhang  2 , Adolfo Fernandez  4 , Dennis Ross-Degnan  2 , Justin B Dimick  5 , J Frank Wharam  2
Affiliations

Concurrent hiatal hernia repair and bariatric surgery: outcomes after sleeve gastrectomy and Roux-en-Y gastric bypass

Kristina H Lewis et al. Surg Obes Relat Dis. 2021 Jan.

Abstract

Background: Hiatal hernias are often repaired concurrently with bariatric surgery to reduce risk of gastroesophageal reflux disease-related complications.

Objectives: To examine the association between concurrent hiatal hernia repair (HHR) and bariatric outcomes.

Setting: A 2010-2017 U.S. commercial insurance claims data set.

Methods: We conducted a retrospective cohort study. We identified adults who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) alone or had bariatric surgery concurrently with HHR. We matched patients with and without HHR and followed patients up to 3 years for incident abdominal operative interventions, bariatric revisions/conversions, and endoscopy. Time to first event for each outcome was compared using multivariable Cox proportional hazards modeling.

Results: We matched 1546 SG patients with HHR to 3170 SG patients without HHR, and we matched 457 RYGB patients with HHR to 1156 RYGB patients without HHR. A total of 73% had a full year of postoperative enrollment. Patients who underwent concurrent SG and HHR were more likely to have additional abdominal operations (adjusted hazard ratio [aHR], 2.1; 95% CI, 1.5-3.1) and endoscopies (aHR, 1.5; 95% CI, 1.2-1.8) but not bariatric revisions/conversions (aHR, 1.7; 95% CI, .6-4.6) by 1 year after surgery, a pattern maintained at 3 years of follow-up. Among RYGB patients, concurrent HHR was associated only with an increased risk of endoscopy (aHR, 1.4; 95% CI, 1.1-1.8)) at 1 year of follow-up, persisting at 3 years.

Conclusions: Concurrent SG/HHR was associated with increased risk of some subsequent operative and nonoperative interventions, a pattern that was not consistently observed for RYGB. Additional studies could examine whether changes to concurrent HHR technique could reduce risk.

Keywords: Gastric bypass; Hiatal hernia repair; Sleeve gastrectomy.

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Figures

Fig. 1.
Fig. 1.
Kaplan-Meier plots of reinterventions up to 1 year after SG or RYGB by hiatal hernia repair. SG = sleeve gastrectomy; RYGB = Roux-en-Y gastric bypass.
See this image and copyright information in PMC

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