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Late-term hiatal hernia after gastric bypass: an emerging problem
Benjamin Clapp1, Loc-Uyen Vo1, Carlos Lodeiro1
1Department of Surgery, Texas Tech University Health Sciences Center Paul Foster School of Medicine, El Paso, Texas.
Summary
Symptomatic hiatal hernias (HH) can occur years after gastric bypass surgery. Surgical repair is often necessary and can typically be performed using minimally invasive techniques.
Area of Science:
- Bariatric surgery outcomes
- Gastrointestinal surgery complications
Background:
- Gastric bypass is a common bariatric procedure with known long-term complications.
- Symptomatic hiatal hernia (HH) with pouch migration is a less frequent but significant complication requiring surgical intervention.
Purpose of the Study:
- To present a case series of patients experiencing late-term hiatal hernias after gastric bypass.
- To discuss the typical presentation and management strategies for this complication.
Main Methods:
- Retrospective chart review of patients undergoing HH repair post-gastric bypass between 2002-2018.
- Data collected included patient demographics, symptoms, diagnostic imaging, and surgical details.
- Literature review on late-term HH after gastric bypass was also conducted.
Main Results:
- Seven patients were analyzed, with an average of 11.9 years between gastric bypass and HH presentation.
- Gastroesophageal reflux was the most common symptom; diagnosis was confirmed via CT and upper GI series showing pouch migration.
- All patients underwent HH repair with bioabsorbable mesh, averaging 105 minutes operative time.
Conclusions:
- Hiatal hernias can manifest years after gastric bypass and become symptomatic.
- Symptomatic HH requires surgical correction, often achievable via minimally invasive approaches.
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