Paraesophageal and sliding-type hiatal hernias are extremely common in patients who suffer from obesity. Concomitant hernia repairs at the time of bariatric surgery have been reported in as high as 20% of all bariatric surgeries. Bioabsorbable tissue matrices have been used to bolster and enhance sutured paraoesophageal hernia defects and reduce local recurrences. To date there exists no large volume study assess outcomes of hiatus hernias repaired at the time of concomitant bariatric surgery, particularly with respect to the use of bioabsorbable tissue matrix.
A single institution retrospective review of a prospectively maintained database was used to identify patients from January 2014 through February 2019 who underwent either gastric sleeve or roux-en-y gastric bypass in addition to hiatal hernia repair with or without bioabsorbable tissue matrix (mesh) reinforcement. A total of 420 patients were included for analysis. Outcomes including post-operative recurrence as confirmed by imaging or endoscopy, reoperation for hiatus hernia, and need for PPI post operatively were assessed.
There were no reoperations for hiatal hernia at an average follow-up of 26.3 months. Total hiatal hernia recurrence rate was 2.4%. Recurrence rates were higher for all procedures if performed without mesh and significantly higher without mesh (p=0.0127) if the bariatric procedure was a sleeve. There was a decline in the need for PPI’s from 41% to 9% over the course of three post-operative years.
Bariatric surgery with concomitant hiatal hernia repair is safe and durable, particularly if performed with absorbable tissue matrix reinforcement.