Impact on perioperative outcomes of concomitant hiatal hernia repair with laparoscopic gastric bypass

The role of laparoscopic hiatal hernia repair (LHHR) at the time of laparoscopic Roux-en-y gastric bypass (LRYGB) is still debatable. This study aims to assess the safety of concomitant LHHR with LRYGB.

This study is a multi-center, retrospective analysis of a large administrative database. The University Health System Consortium (UHC) is a group of 112 academic medical centers and 256 of their affiliated hospitals. The UHC database was queried using International Classification of Diseases-9 codes and main outcome measures were analyzed.

From October 2006 to January 2010, we found 33,717 patients who underwent LRYGB and did not have a hiatal hernia. In this same time period, 644 patients underwent concomitant LRYGB and LHHR, while 1,589 patients underwent LRYGB without repair of their hiatal hernias. On comparison of patients undergoing LRYGB with simultaneous LHHR with those who underwent LRYGB without a diagnosis of HH, there was no significant difference in mortality, morbidity, length of stay (LOS), 30-day readmission, or cost shown. On comparison of patients with HH who underwent LRYGB and simultaneous LHHR with those who had LRYGB without LHHR, no significant difference with regards to all the outcome measures was also shown.

In conclusion, concomitant hiatal hernia repair with LRYGB appears to be safe and feasible. These patients did not have any significant differences in morbidity, mortality, LOS, readmission rate, or cost. Randomized controlled studies should further look into the benefit of hiatal hernia repair in regards to reflux symptoms and weight loss for LRYGB patients.