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. 2022 Sep 21;22(1):347.
doi: 10.1186/s12893-022-01800-y.

Hiatal reconstruction is safe and effective for control of reflux after laparoscopic sleeve gastrectomy

Ben Indja  1   2   3 , Daniel L Chan  4   5 , Michael L Talbot  4   5   6
Affiliations

Hiatal reconstruction is safe and effective for control of reflux after laparoscopic sleeve gastrectomy

Ben Indja et al. BMC Surg. .

Abstract

Background: Gastroesophageal reflux is a known complication following laparoscopic sleeve gastrectomy (LSG) as anatomical changes predispose to reduced lower esophageal sphincter pressure and development of hiatus hernia. The mainstay of surgical management has been Roux-en-Y gastric bypass (RYGB) which is not without risk. Hiatus hernia repair (HHR) with surgical reattachment of the oesophagus to the crura, recreating the phreno-esophageal ligament is a simple procedure specifically targeting a number of anatomical changes responsible for reflux in this population.

Methods: We conducted a single centre retrospective analysis of adult patients with post-sleeve reflux refractory to medical treatment, managed with either HHR, RYGB or One-anastomosis Duodenal switch (OADS). PPI use and symptoms of reflux were assessed at early and mid-term time points via validated questionnaires.

Results: 99 patients were included, of these the surgical procedure was HHR alone in 58, RYGB in 29 and OADS in 12. At early follow-up control of reflux symptoms was achieved in 72.4% after HHR, 82.1% after RYGB and 100% after OADS with no significant difference between groups (p = 0.09). At mid-term followup (median 10 months IQR 7-21) there was no significant difference in the presence of symptomatic reflux as determined by post-op Visick score nor a difference in PPI use. The GerdQ score was significantly lower after OADS as compared to HHR and RYGB (4.6 ± 2.3 vs 7.7 ± 2.2 vs 8.7 ± 3.5, p = 0.006).

Conclusion: HHR with reconstruction of the phreno-esophageal ligament is a safe and effective procedure for patients with reflux after LSG, that avoids more complex operations such as RYGB and OADS and their associated long-term sequelae.

Keywords: Bariatric surgery complications; Gastroesophageal reflux; Hiatal hernia; Laparoscopic sleeve gastrectomy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a 3D CT scan post sleeve gastrectomy demonstrating hiatal hernia. b 3D CT scan post sleeve gastrectomy demonstrating small hiatal hernia and angularis stenosis
Fig. 2
Fig. 2
Post-sleeve reflux algorithm to guide workup after failure of medical therapy. HH hiatus hernia, HHR hiatus hernia repair, RYGB Roux-en-Y gastric bypass, OADS one-anastomosis duodenal switch
Fig. 3
Fig. 3
PPI requirement and early control of reflux at early follow-up. HHR hiatus hernia repair, RYGB Roux-en-Y gastric bypass, OADS one-anastomosis duodenal switch
See this image and copyright information in PMC

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