Concomitant hiatal hernia repair during bariatric surgery: does the reinforcement make the difference?

Area of Science:

• Bariatric Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Hiatal hernia repair (HHR) during bariatric procedures, particularly laparoscopic sleeve gastrectomy (LSG), remains a topic of debate.
• The study addresses the long-term outcomes of concomitant HHR, focusing on the safety and efficacy of posterior cruroplasty (PC).

Purpose of the Study:

• To evaluate the long-term results of concomitant hiatal hernia repair (HHR) during bariatric surgery.
• To assess the safety and efficacy of posterior cruroplasty (PC), with or without biosynthetic mesh reinforcement.
• To identify factors influencing hiatal hernia recurrence after repair.

Main Methods:

• A prospective database of 1876 bariatric operations (2011-2019) was analyzed for concomitant HHR.
• Intraoperative hiatal surface area (HSA) was routinely measured.
• Patients were divided into simple PC (Group A) and reinforced PC (Group B) groups.

Main Results:

• A total of 250 patients (13%) underwent concomitant HHR. Reinforced PC showed a trend towards lower recurrence rates (4% vs. 8% for simple PC).
• No mesh-related complications were observed during perioperative or long-term follow-up (mean 50 months).
• Cox hazard analysis indicated that using more than four stitches for cruroplasty was a negative factor for recurrence (HR=8; P<0.05).

Conclusions:

• Aggressive identification and repair of hiatal hernias during bariatric surgery are advisable to achieve low recurrence rates.
• Reinforcement with a biosynthetic, absorbable mesh appears to improve long-term outcomes, particularly for larger hiatal defects.
• Reinforcement is recommended even for smaller defects in the obese population.