Our Summary

A hiatal hernia is a condition where part of your stomach pushes up through your diaphragm into your chest. The larger the hernia, the more likely it is to happen again after being fixed, especially in overweight patients due to the extra pressure in their abdomen. This study wanted to see if pairing a hiatal hernia repair (HHR) with weight loss surgery (BAR) would lower the chances of the hernia happening again, compared to those who had the hernia repair with a different procedure called fundoplication (FP).

The researchers looked back at patients who had these surgeries between 2007 and 2014. They didn’t include patients who had small hernias, those who had a different type of repair, or those who only had a procedure to attach their stomach to the abdominal wall.

The main things they were checking for were whether the hernia happened again and if acid reflux symptoms got better. They compared 58 patients who had the hernia repair with weight loss surgery to 30 patients who had the hernia repair with the other procedure.

They found that only 12% of the patients who paired the hernia repair with weight loss surgery had their hernia come back, compared to 38% of patients who had the other procedure (a statistically significant difference). As for acid reflux symptoms, 78% of those who had the hernia repair with the other procedure saw improvements, compared to 84% of those who had the hernia repair with weight loss surgery (not a statistically significant difference).

So, the conclusion of the research is that pairing the hernia repair with weight loss surgery can lead to a lower chance of the hernia happening again compared to pairing it with the other procedure.

FAQs

  1. What is the recurrence rate of hiatal hernias after conventional repair?
  2. Why are recurrence rates higher in obese patients?
  3. Does combining hiatal hernia repair with bariatric surgery result in a lower hernia recurrence rate compared to hiatal hernia repair with fundoplication?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hiatal hernia repair is to consider combining the repair with bariatric surgery if they are obese, as weight loss can help decrease intra-abdominal pressure and potentially lower the risk of hernia recurrence.

Suitable For

Patients who are obese and have large hiatal hernias are typically recommended hiatal hernia repair. Additionally, patients who have not had success with conservative treatments for their hiatal hernia, such as medication or lifestyle changes, may also be recommended for surgery. Patients who have severe symptoms of gastroesophageal reflux disease (GERD) or complications related to their hiatal hernia, such as Barrett’s esophagus or esophageal strictures, may also be candidates for hiatal hernia repair.

Timeline

Before hiatal hernia repair, a patient may experience symptoms such as heartburn, regurgitation, chest pain, difficulty swallowing, and reflux. They may undergo diagnostic tests such as endoscopy, pH monitoring, and imaging studies to confirm the diagnosis of a hiatal hernia.

After hiatal hernia repair, the patient will typically undergo a period of recovery in the hospital or at home. They may experience some pain, swelling, and difficulty swallowing for a few weeks after surgery. They will be advised to follow a special diet and avoid certain foods to prevent complications.

Over time, the patient should experience relief from their symptoms and improved quality of life. They may need to follow up with their surgeon for post-operative appointments and monitoring. In the case of a large hiatal hernia repair combined with bariatric surgery, the patient may also experience weight loss and improved overall health outcomes in addition to a lower risk of hernia recurrence.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with hiatal hernia repair surgery, particularly with the specific type of repair being recommended (e.g. bariatric surgery vs. fundoplication)?

  2. How long is the recovery time expected to be after the surgery, and what restrictions or lifestyle changes will be necessary during the recovery period?

  3. What is the success rate of the specific type of repair being recommended for hiatal hernia, and what factors may affect the likelihood of recurrence?

  4. Will I need any additional follow-up procedures or interventions after the initial surgery, and what is the long-term outlook for my condition?

  5. Are there any dietary or activity restrictions I should be aware of after the surgery, and how can I best manage my symptoms and prevent future issues with my hiatal hernia?

  6. How experienced is the surgical team in performing hiatal hernia repairs, and what is their success rate with this specific procedure?

  7. Are there any alternative treatment options or approaches that may be appropriate for my specific situation, and how do they compare to the recommended surgical repair in terms of effectiveness and risks?

  8. Will I need to make any changes to my current medications or health management routine before or after the surgery, and how can I best prepare for a successful outcome?

  9. What can I expect in terms of pain management and post-operative care after the surgery, and how will my recovery progress be monitored and managed by the medical team?

  10. How soon can I expect to see improvements in my symptoms and quality of life after the surgery, and what signs should I watch for that may indicate a need for further medical attention or intervention?

Reference

Authors: Sutherland V, Kuwada T, Gersin K, Simms C, Stefanidis D. Journal: Am Surg. 2016 Aug;82(8):743-7. PMID: 27657592