Our Summary

This research paper looks into a rare complication that can occur after a certain type of weight loss surgery, known as laparoscopic Roux-en-Y gastric bypass. The complication is a hiatal hernia - a condition where part of the stomach pushes up through the diaphragm muscle. This can sometimes occur with the migration of a pouch created during the bypass surgery. It’s not currently clear how effective surgical repair is for this issue.

The study looks at patients who had this hernia repair between 2010 and 2022, after having the bypass surgery. They specifically focused on patients who just had the hernia repair, not those who also had other weight loss surgery revisions at the same time.

Out of 44 patients, most noticed the hernia because of difficulty swallowing (52%), acid reflux (39%), and abdominal pain (36%). The hernia repair was done using minimally invasive surgery, mostly laparoscopic but a small percentage was robotic. Nearly all of the patients had nonabsorbable suture used in the repair, and about a third had bioabsorbable mesh.

After about a month, 70% of patients reported that all their hernia symptoms were gone, and 23% said some symptoms were gone. However, 2 patients had the hernia come back as seen in radiologic imaging, and one of them needed another surgery. So while the short-term results look good, more follow-up is needed to see how well this repair works in the long term.

FAQs

  1. What is a hiatal hernia and how is it related to weight loss surgery?
  2. How was the hiatal hernia repair conducted in the study and what materials were used?
  3. What were the short-term results of the hernia repair and what further research is needed?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hiatal hernia repair is to follow post-operative care instructions carefully, including avoiding heavy lifting, sticking to a soft diet initially, and taking prescribed medications as directed. It’s also important to attend follow-up appointments to monitor healing and address any concerns promptly. Additionally, maintaining a healthy weight and avoiding triggers for acid reflux can help prevent future hernia complications.

Suitable For

Patients who are typically recommended for hiatal hernia repair are those who have symptoms such as difficulty swallowing, acid reflux, and abdominal pain related to the hernia. In this study, the patients had undergone laparoscopic Roux-en-Y gastric bypass surgery and developed a hiatal hernia as a rare complication. The hernia repair was done using minimally invasive techniques, with the majority of patients experiencing relief from their symptoms after the surgery.

It is important for patients with symptomatic hiatal hernias to consult with their healthcare provider to determine the best course of treatment. While surgical repair may be effective in relieving symptoms in the short term, long-term follow-up is needed to assess the durability of the repair.

Timeline

In summary, before the hiatal hernia repair, patients typically experience symptoms such as difficulty swallowing, acid reflux, and abdominal pain. The repair surgery is usually done using minimally invasive techniques, with nonabsorbable suture or bioabsorbable mesh used for the repair.

After the surgery, most patients reported that their hernia symptoms were either completely gone or improved. However, a small percentage of patients experienced a recurrence of the hernia, with one patient needing a second surgery. Long-term follow-up is needed to determine the effectiveness of the repair in preventing future hernia recurrence.

What to Ask Your Doctor

  1. What symptoms should I look out for that may indicate a hiatal hernia after my weight loss surgery?

  2. How common is it for patients who have had laparoscopic Roux-en-Y gastric bypass to develop a hiatal hernia?

  3. What are the potential risks and complications associated with hiatal hernia repair surgery?

  4. What type of surgical approach will be used for my hernia repair (laparoscopic, robotic, open)?

  5. Will nonabsorbable sutures or mesh be used in my hernia repair, and what are the differences between the two in terms of effectiveness and potential risks?

  6. How long is the recovery period after hiatal hernia repair surgery, and what can I expect in terms of pain and limitations during this time?

  7. Are there any dietary or lifestyle changes I should make after my hernia repair surgery to prevent the hernia from recurring?

  8. How likely is it for the hiatal hernia to come back after surgery, and what are the signs that it may be recurring?

  9. What is the long-term success rate of hiatal hernia repair surgery in patients who have had laparoscopic Roux-en-Y gastric bypass?

  10. How often will I need follow-up appointments to monitor the success of the hernia repair and address any potential issues that may arise?

Reference

Authors: Vaughan T, Romero-Velez G, Barajas-Gamboa JS, Dang JT, Rodriguez J, Navarrete S, Strong AT, Rosenthal R, Corcelles R, Kroh M. Journal: Surg Obes Relat Dis. 2024 May;20(5):432-437. doi: 10.1016/j.soard.2023.11.012. Epub 2023 Nov 25. PMID: 38151414