Hiatal Hernia Following a Sleeve Gastrectomy

A known risk factor for a hiatal hernia (HH) is obesity. However, the data are limited regarding the association between bariatric surgery and an HH, as well as the timing of surgical repair. This study examines morbidly obese patients who underwent a sleeve gastrectomy (SG) and required a subsequent HH repair.

A retrospective review was performed of a prospective database of patients who underwent a laparoscopic SG at a Veterans Affairs Medical Center from 2013 to 2019. Patient demographics, weight loss, and resolution of comorbidities were analyzed using univariate and multivariate analysis. The presence of reflux with and without evidence of an HH at 5 years postoperatively was assessed. An alpha-level of 0.05 determined significance, and statistical analyses were performed using SAS version 9.4.

A total of 152 patients underwent an SG and 10 (6.6%) patients developed an HH with a significantly higher TWL (total weight loss) at 1 and 3 years postoperatively. TWL at 5 years was greater in the HH group, though this was not statistically significant. Presence of an HH predicted postoperative GERD compared to those without an HH (90% versus 47.2% respectively, P = .018). Presence of GERD preoperatively predicted a HH postoperatively, and all patients with a HH underwent repair at 5.5 years following SG.

Additional imaging or an esophagogastroduodenoscopy should be used for patients with GERD and a TWL of approximately 20% at 5 years after SG to evaluate for an HH. This study sheds insight between an SG and the development of an HH.