Outcomes of hiatal hernia repair after Roux-en-Y gastric bypass: largest retrospective cohort study to date

Roux-en-Y gastric bypass (RYGB) is the optimal operation for obesity and concomitant gastroesophageal reflux disease (GERD). Post-RYGB de novo or recurrent hiatal hernias (HH) can lead to GERD and nonspecific gastrointestinal symptoms that require subsequent HH repair (HHR).

Describe the evaluation, surgical indications, and outcomes of HHR post-RYGB.

University hospital, USA.

A retrospective cohort study of patients who underwent HHR after RYGB over 15 years was performed. Demographic and clinical data (including body mass index (BMI), preoperative work-up, operative details, and postoperative outcomes) were analyzed.

Forty-five patients (age of 54.8 ± 9.3 years, BMI of 31.3 ± 6.7 kg/m²) underwent HHR at a median time of 8.0 (IQR 8) years after RYGB. GERD with HH was the most common surgical indication (57.8%), while abdominal pain (17.8%), bile reflux (13.3%), and nausea/vomiting (11.1%) were other indications. Isolated HHR was performed in only 17 patients (37.8%), while 22 (48.9%) had underwent revision of concomitant anatomic abnormalities. Overall, 77.8% reported symptom improvement, and 55.5% reported decreased antacid requirement at median follow-up of 7.2 (IQR 45.3) months. Clinical success was high regardless of surgical indication or anatomic considerations. Older age was associated with greater likelihood of symptom improvement.

In this largest series, to date, documenting post-RYGB HHR outcomes, patients had complex symptomatology, and HHR was often accompanied by additional operations. While most patients experienced improved symptoms, many still required antacid therapy. Adequate preoperative workup, careful patient selection, and outcome expectations management are important, given the variability of symptom resolution after surgery.