Our Summary

This research paper examines the relationship between the repair of hiatal hernias during weight loss surgery and the outcomes of the weight loss surgery. The researchers looked at data from US health insurance claims between 2010 and 2017. They identified adults who either had weight loss surgery alone, or had it at the same time as a hernia repair. They then compared the results for each group over a period of up to three years, looking at things like further abdominal operations, changes to the weight loss surgery, and the use of an endoscope.

They found that patients who had a hernia repair at the same time as a specific type of weight loss surgery called sleeve gastrectomy were more likely to have further abdominal operations and endoscopies, but not changes to the weight loss surgery, within a year of the surgery. This pattern continued for up to three years. For patients who had a different type of weight loss surgery called Roux-en-Y gastric bypass, having a hernia repair at the same time only increased the likelihood of needing an endoscopy within a year, and this continued for up to three years.

The researchers concluded that having a hernia repair at the same time as sleeve gastrectomy increases the risk of needing further operations or procedures, but this was not always the case for Roux-en-Y gastric bypass. They suggest that further research could look at whether changing the way the hernia repair is done could reduce these risks.

FAQs

  1. What is the relationship between hiatal hernia repair and weight loss surgery outcomes?
  2. Does having a hernia repair at the same time as weight loss surgery increase the likelihood of needing further operations or procedures?
  3. Could changing the way the hernia repair is done potentially reduce the risk of needing further operations or procedures?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hiatal hernia repair is to carefully consider the timing of the hernia repair in relation to any weight loss surgery. It is important to weigh the potential risks and benefits of having them done simultaneously, as there may be an increased risk of needing further operations or procedures in the short term. Patients should discuss their individual situation with their healthcare provider to determine the best course of action.

Suitable For

Patients who are typically recommended hiatal hernia repair are those who are undergoing weight loss surgery, particularly sleeve gastrectomy. This research suggests that patients who have a hiatal hernia repair at the same time as sleeve gastrectomy may have an increased risk of needing further abdominal operations and endoscopies within the first year and up to three years post-surgery. However, the risks may not be as significant for patients undergoing Roux-en-Y gastric bypass. Further research is needed to determine if modifying the approach to hiatal hernia repair during weight loss surgery could reduce these risks.

Timeline

  • Before hiatal hernia repair: The patient may experience symptoms such as heartburn, chest pain, difficulty swallowing, regurgitation of food, and feeling full quickly after eating. They may undergo diagnostic tests such as an endoscopy or barium swallow to confirm the presence of a hiatal hernia.

  • During hiatal hernia repair: The patient undergoes surgery to repair the hiatal hernia, which may involve pulling the stomach down into the abdomen, tightening the opening in the diaphragm, and reinforcing the weakened muscles. The surgery is typically done laparoscopically, with small incisions and a camera to guide the surgeon.

  • After hiatal hernia repair: The patient may experience some pain and discomfort in the days following surgery, and will need to follow specific dietary and activity guidelines to aid in recovery. Over time, the symptoms of the hiatal hernia should improve, with a reduction in heartburn, chest pain, and other symptoms. The patient may also need to undergo follow-up appointments with their surgeon to ensure proper healing and monitor for any complications.

What to Ask Your Doctor

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

  1. What are the potential risks and complications associated with hiatal hernia repair?
  2. How will the hernia repair affect my recovery from weight loss surgery?
  3. Will I need additional procedures or surgeries in the future if I have a hernia repair at the same time as weight loss surgery?
  4. How will the hernia repair impact the long-term success of my weight loss surgery?
  5. Are there alternative treatment options for my hiatal hernia that do not involve surgery?
  6. What is the success rate of hiatal hernia repair when performed during weight loss surgery?
  7. How experienced are you in performing hiatal hernia repairs during weight loss surgery?
  8. What is the recovery process like after having a hiatal hernia repair during weight loss surgery?
  9. Will I need to follow any specific dietary or lifestyle guidelines after the hernia repair?
  10. Are there any factors that may make me a poor candidate for having a hiatal hernia repair during weight loss surgery?

Reference

Authors: Lewis KH, Callaway K, Argetsinger S, Wallace J, Arterburn DE, Zhang F, Fernandez A, Ross-Degnan D, Dimick JB, Wharam JF. Journal: Surg Obes Relat Dis. 2021 Jan;17(1):72-80. doi: 10.1016/j.soard.2020.08.035. Epub 2020 Sep 3. PMID: 33109444