Hiatal Hernia Recurrence Following Abdominoplasty: A Proposed Algorithm for Screening and Management

Area of Science:

• Gastroenterology
• Plastic Surgery
• Bariatric Surgery

Background:

• Hiatal hernias affect 20-50% of bariatric surgery patients.
• Concurrent hiatal hernia repair is common during bariatric surgery to prevent GERD.
• Abdominoplasty increases intra-abdominal pressure, raising the risk of hiatal hernia recurrence after laparoscopic repair.

Purpose of the Study:

• Review a case of recurrent hiatal hernia post-abdominoplasty.
• Explore literature on screening and managing hiatal hernias in post-bariatric patients.
• Propose an algorithm for pre-abdominoplasty hiatal hernia management in bariatric patients.

Main Methods:

• Case report of a 40-year-old female with obesity and GERD.
• Patient underwent Roux-en-Y gastric bypass, hiatal hernia repair, and abdominoplasty with rectus plication.
• Post-abdominoplasty evaluation included esophagogastroduodenoscopy revealing recurrent hiatal hernia.

Main Results:

• The patient experienced intractable reflux and PO intolerance after abdominoplasty.
• Esophagogastroduodenoscopy confirmed a recurrent hiatal hernia.
• The recurrence was not present prior to the abdominoplasty procedure.

Conclusions:

• Screening bariatric patients for hiatal hernia history before abdominoplasty is recommended.
• Further research is needed to establish prophylactic repair thresholds and management strategies.
• Surgeons must counsel patients on risks and monitor for postoperative GERD or hernia recurrence.