Our Summary

This research paper looked into the impact of simultaneous hiatal hernia repair (HHR) during a type of weight loss surgery called laparoscopic sleeve gastrectomy (LSG) on acid reflux symptoms. The study used medical data from patients who underwent primary LSG between 2015 and 2019 and completed a special survey about their acid reflux symptoms before and after the surgery.

The researchers found that about one-third of the patients also had an HHR during their LSG. These patients were generally older, skinnier before the operation, and more likely to be female than those who only had LSG.

Among the patients who had HHR, those who had a specific type of repair (posterior HHR) experienced a significant improvement in their acid reflux symptoms and a lower chance of developing new symptoms a year after the surgery. Another type of repair (anterior HHR) was associated with higher rates of bleeding and hospital readmissions and didn’t improve symptoms.

In conclusion, the study suggests that a simultaneous posterior HHR during weight loss surgery can help improve acid reflux symptoms but the anterior repair doesn’t provide any benefit and should be avoided.

FAQs

  1. What type of hiatal hernia repair was found to improve acid reflux symptoms in patients undergoing laparoscopic sleeve gastrectomy?
  2. What is the potential downside of having an anterior hiatal hernia repair during weight loss surgery?
  3. What type of patients were more likely to have a hiatal hernia repair during their laparoscopic sleeve gastrectomy according to the study?

Doctor’s Tip

A helpful tip from a doctor might be to discuss with your surgeon the possibility of having a posterior hiatal hernia repair during weight loss surgery if you are experiencing acid reflux symptoms. This type of repair has been shown to improve symptoms and reduce the risk of developing new ones post-surgery. It is important to weigh the benefits and risks with your healthcare provider to determine the best course of action for your specific situation.

Suitable For

Patients who are recommended for hiatal hernia repair typically have symptoms of acid reflux, such as heartburn, regurgitation, chest pain, and difficulty swallowing, that are not adequately controlled with medication. They may also have a large hiatal hernia, where the stomach protrudes through the diaphragm into the chest cavity, leading to complications such as gastroesophageal reflux disease (GERD) or Barrett’s esophagus.

Additionally, patients who are undergoing weight loss surgery, such as LSG, may be recommended for simultaneous HHR if they have a hiatal hernia that could potentially worsen or cause complications during or after the weight loss procedure. These patients may have a history of GERD or other gastrointestinal issues that could be exacerbated by the hiatal hernia.

Overall, patients who are recommended for hiatal hernia repair are those who would benefit from the improvement of acid reflux symptoms and prevention of complications related to the hernia. It is important for healthcare providers to carefully assess each patient’s individual situation and determine the most appropriate course of treatment based on their specific needs and medical history.

Timeline

Before the hiatal hernia repair:

  • Patients undergo laparoscopic sleeve gastrectomy (LSG) for weight loss.
  • Patients complete a special survey about their acid reflux symptoms.
  • About one-third of the patients also have a hiatal hernia repair (HHR) during LSG.
  • Patients who undergo HHR are generally older, skinnier before the operation, and more likely to be female.

After the hiatal hernia repair:

  • Patients who have a posterior HHR experience significant improvement in their acid reflux symptoms.
  • Patients who have an anterior HHR have higher rates of bleeding and hospital readmissions and do not experience improvement in symptoms.
  • Simultaneous posterior HHR during weight loss surgery can help improve acid reflux symptoms, while anterior repair should be avoided.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hiatal hernia repair include:

  1. Is a hiatal hernia common in patients undergoing weight loss surgery like laparoscopic sleeve gastrectomy?
  2. What are the potential benefits of having a simultaneous hiatal hernia repair during weight loss surgery?
  3. Are there different types of hiatal hernia repair procedures, and which one would be most effective for me?
  4. What are the risks or complications associated with hiatal hernia repair during weight loss surgery?
  5. How will hiatal hernia repair impact my recovery time after weight loss surgery?
  6. Will I still need to manage my acid reflux symptoms after having a hiatal hernia repair?
  7. How will the hiatal hernia repair affect my long-term weight loss goals and overall health?
  8. Are there any specific lifestyle changes or dietary modifications I should make after undergoing hiatal hernia repair during weight loss surgery?
  9. How often will I need to follow up with my doctor post-surgery to monitor my hiatal hernia repair and acid reflux symptoms?
  10. Are there any alternative treatment options for managing acid reflux symptoms if hiatal hernia repair is not recommended for me?

Reference

Authors: Hider AM, Bonham AJ, Carlin AM, Finks JF, Ghaferi AA, Varban OA, Ehlers AP. Journal: Surg Obes Relat Dis. 2023 Jun;19(6):619-625. doi: 10.1016/j.soard.2022.12.021. Epub 2022 Dec 11. PMID: 36586763