Our Summary

This study brings together a panel of experts to develop guidelines for treating hiatal hernia (HH), a common condition where part of the stomach pushes up into the chest. The team reviewed existing research to answer four key questions about HH treatment: whether to surgically treat patients without symptoms or just monitor them, whether to use a mesh in surgery, whether to perform a procedure called fundoplication, and whether to do a gastric bypass or another fundoplication in cases of recurrent HH.

The panel suggested routinely performing a fundoplication when repairing a HH, although the evidence for this recommendation was not very strong. There wasn’t enough evidence to guide decisions on the other questions, so the panel gave expert opinions instead. They suggested that some patients without symptoms might benefit from surgery, and that a gastric bypass might be a good option for some patients with recurring HH. The panel couldn’t make a definitive recommendation on using mesh in surgery due to conflicting evidence.

The panel emphasized that these guidelines should help doctors make decisions about HH treatment, but it’s important to consider patients’ values and preferences to get the best results. They also identified areas for future research to strengthen these guidelines.

FAQs

  1. What are the key questions the panel aimed to answer about hiatal hernia treatment?
  2. What were the panel’s recommendations regarding the use of a fundoplication or gastric bypass in treating hiatal hernias?
  3. Why couldn’t the panel conclusively recommend the use of mesh in hiatal hernia surgeries?

Doctor’s Tip

One helpful tip a doctor might tell a patient about gastric bypass is to follow a strict post-operative diet and exercise plan to ensure successful weight loss and maintain overall health. It is important for patients to make healthy food choices, stay hydrated, and participate in regular physical activity to support their weight loss goals and prevent complications. Additionally, patients should attend follow-up appointments with their healthcare team to monitor their progress and address any concerns. By following these guidelines, patients can maximize the benefits of gastric bypass surgery and improve their overall quality of life.

Suitable For

Patients who are typically recommended gastric bypass are those who are severely obese and have not been able to lose weight through other methods such as diet and exercise. Gastric bypass surgery is usually recommended for individuals with a body mass index (BMI) of 40 or higher, or a BMI of 35 or higher with obesity-related health conditions such as type 2 diabetes, high blood pressure, or sleep apnea. Additionally, patients who have tried and failed to lose weight through other means and are motivated to make lifestyle changes post-surgery may also be recommended for gastric bypass.

Timeline

Overall, the timeline of a patient’s experience before and after gastric bypass surgery for treating hiatal hernia includes:

Before surgery:

  1. Patient is diagnosed with hiatal hernia and discusses treatment options with their healthcare provider.
  2. Patient may undergo various tests and evaluations to determine if they are a candidate for surgery, such as imaging studies and consultations with specialists.
  3. Patient may be advised to make lifestyle changes, such as losing weight or changing their diet, to improve surgical outcomes.
  4. Patient and healthcare provider decide on the best treatment approach, including whether to proceed with gastric bypass surgery.

After surgery:

  1. Patient undergoes gastric bypass surgery to repair the hiatal hernia.
  2. Patient is monitored closely in the hospital for any complications or side effects of the surgery.
  3. Patient follows a specific post-operative diet and exercise plan to aid in recovery and promote weight loss.
  4. Patient attends follow-up appointments with their healthcare provider to monitor progress and address any concerns.
  5. Patient may experience improvements in symptoms related to the hiatal hernia, such as heartburn or difficulty swallowing.
  6. Patient continues to follow-up with their healthcare provider long-term to ensure the success of the surgery and address any potential complications or issues.

What to Ask Your Doctor

Some questions a patient should ask their doctor about gastric bypass surgery for treating hiatal hernia may include:

  1. Is gastric bypass surgery the best treatment option for my hiatal hernia, or are there other surgical or non-surgical options to consider?
  2. What are the potential risks and complications associated with gastric bypass surgery for hiatal hernia?
  3. How long is the recovery period after gastric bypass surgery, and what can I expect in terms of pain and discomfort?
  4. Will I need to make any lifestyle changes or follow a specific diet after undergoing gastric bypass surgery for hiatal hernia?
  5. How successful is gastric bypass surgery in treating hiatal hernia, and what are the chances of the hernia recurring?
  6. Are there any long-term implications or considerations to keep in mind after undergoing gastric bypass surgery for hiatal hernia?
  7. How experienced is the medical team in performing gastric bypass surgery for hiatal hernia, and what is the success rate of the procedure at this facility?
  8. Are there any specific pre-operative tests or evaluations that need to be done before undergoing gastric bypass surgery for hiatal hernia?
  9. What follow-up care or monitoring will be required after gastric bypass surgery for hiatal hernia, and how often will I need to see my doctor for check-ups?
  10. Are there any support groups or resources available for patients undergoing gastric bypass surgery for hiatal hernia to help with recovery and long-term success?

Reference

Authors: Daly S, Kumar SS, Collings AT, Hanna NM, Pandya YK, Kurtz J, Kooragayala K, Barber MW, Paranyak M, Kurian M, Chiu J, Ansari MT, Slater BJ, Kohn GP. Journal: Surg Endosc. 2024 Sep;38(9):4765-4775. doi: 10.1007/s00464-024-11092-3. Epub 2024 Jul 30. PMID: 39080063