Management of paraesophageal hiatal hernia alongside weight reduction surgery is a topic of continued investigation. We present a query of national bariatric surgery data investigating the efficacy of concurrent laparoscopic sleeve gastrectomy and paraesophageal hiatal hernia repair (LSGPEHR) as compared to laparoscopic sleeve gastrectomy (LSG).
Patients were identified from the 2016 American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (ACS-MBSAQIP). Laparoscopic sleeve gastrectomy was identified by Current Procedure Terminology (CPT) code 43775 and subdivided by presence or absence of concurrent laparoscopic paraesophageal hiatal hernia repair by codes 43280, 43281, and 43282.
338,061 patients (271,374 LSG, 66,687 LSGPEHR) were identified. Significantly elevated rates of preoperative gastroesophageal reflux disease were noted among the LSGPEHR cohort, as were rates of diabetes, hypertension, and venous stasis (p<.05). Concurrent repair of paraesophageal hiatal hernia was associated with increased length of surgery, staple line reinforcement, and oversewing with shortened sleeve-pylorus distance. Postoperative complication rates were comparable however increased rates of postoperative vein thrombosis and wound disruption were observed in the LSGPEHR group. Statistically significant but small increases in readmission and reoperation rates were also observed with concurrent repair.
Our findings represent the first published study investigating the 2016 ACS MBSAQIP database pertaining to laparoscopic sleeve gastrectomy and paraesophageal hiatal hernia repair. Evidence suggests both techniques are comparable, with few significant clinical differences in perioperative course. The decision to repair paraesophageal hiatal hernia during laparoscopic sleeve gastrectomy appears to be safe and efficacious however surgeon familiarity should guide intraoperative decision making.