Concomitant Laparoscopic Adjustable Gastric Banding and Hiatal Hernia Repair, A Retrospective Cohort Study

Abstract

Background: The recognition and management of diaphragmatic hernias during bariatric surgery remains a challenge and the need for its repair has changed during the last decade. The aim of the current study was to evaluate whether Laparoscopic Adjustable Gastric Banding (LAGB) is a viable solution for patients with a concomitant hiatal hernia discovered during surgery. Methods: A retrospective cohort study, which included the exposed group composed of patients who underwent LAGB between 2000 and 2016, with a concomitant hiatal hernia discovered during surgery. A control group was randomly chosen from a group of patients who underwent a primary LAGB between these years. The two groups were matched regarding basic demographic variables. Results: The study included 59 patients, 12 in the exposed group and 47 in the non-exposed (no hernia repair) group. In both groups, BMI decreased after the procedure without significant statistical differences. There was no significant difference in the BAROS score between the two groups. No pronounced difference was found in the general amount of post-surgical complications in the study group compared to the control group. Operating time was longer in the study group. Conclusion: Hiatal hernia repair during LAGB is as effective as primary LAGB without hiatal hernia. bypass, sleeve gastrectomy, and the placement of adjustable gastric bands, all detected hiatal hernias should be repaired. But the level of evidence for these guidelines are considered not evidence based. We have shown in a previous study that the decision not to close a hiatal hernia discovered accidentally during LAGB, could have grave consequences [2]. The Society of American Gastrointestinal and Endoscopic Surgeons has also stated that laparoscopic hiatal hernia repair is as effective as open transabdominal repair, with a reduced rate of perioperative morbidity and with shorter hospital stays. It is the preferred approach for the majority of hiatal hernias, again with no real evidence for this. It seems that there is inadequate long-term data on which to base a recommendation either for or against the use of mesh at the hiatus. The ideal mesh, or way of hiatal closure, and technique are unknown at this point. The aim of the current study was to evaluate whether hiatal hernia repair during a laparoscopic gastric band placement is a viable solution for patients with a concomitant hiatal hernia discovered during surgery.