Laparoscopic Hiatus Hernia Repair with BIO-A(®) mesh is Safe and Effective for Patients Suffering Severe Gastro-Esophageal Reflux Disease After Sleeve Gastrectomy - A Single Surgeon Experience.

内容摘要

There is a complex relationship between gastroesophageal reflux disease (GORD), hiatus hernia, obesity, and metabolic bariatric surgery. We report the outcomes of laparoscopic hiatus hernia repair (HHR) with BIO-A&#xae; mesh in the management of GORD post LSG in patients who developed a hiatus hernia with migration of the proximal gastric sleeve. A retrospective review of 50 patients who previously underwent LSG and revisional surgery (HHR, n&#x2009;=&#x2009;25; RYGB, n&#x2009;=&#x2009;25) between 2011 and 2022. The modified DeMeester scoring system was used to assess the severity of the patient's GORD symptoms pre-HHR/pre-RYGB and 6 months post-op. Twenty-five patients underwent HHR with BIO-A&#xae; mesh following a previous LSG. The severity of GORD six months post-HHR was significantly lower (0.96&#x2009;&#xb1;&#x2009;0.84 vs. 2.60&#x2009;&#xb1;&#x2009;0.50, p&#x2009;=&#x2009;<&#x2009;0.0001). After HHR, 3/25 (12%) patients had ongoing GORD symptoms that were not medically controlled and underwent conversion to RYGB. In contrast, 25 patients underwent direct conversion to RYGB following a previous LSG. The severity of GORD at 6 months post-RYBG was significantly lower (0.40&#x2009;&#xb1;&#x2009;0.50 vs. 2.36&#x2009;&#xb1;&#x2009;0.64, p&#x2009;=&#x2009;<&#x2009;0.0001). At six months, there was no significant difference in GORD symptoms when HHR was compared with RYGB (3.32&#x2009;&#xb1;&#x2009;1.6 vs. 3.76&#x2009;&#xb1;&#x2009;1.54, p&#x2009;=&#x2009;0.4296). In appropriately selected patients, HHR with BIO-A&#xae; mesh appears safe and effective in managing persistent GORD following LSG, within the limits of this study. However further research is needed to explore its role and the long-term outcomes.