Hiatal Hernia Following a Sleeve Gastrectomy

Area of Science:

• Bariatric Surgery
• Gastroenterology
• Hernia Surgery

Background:

• Obesity is a known risk factor for hiatal hernia (HH).
• Limited data exist on the association between bariatric surgery and HH.
• This study investigates HH development after sleeve gastrectomy (SG).

Purpose of the Study:

• To examine the incidence of hiatal hernia (HH) in morbidly obese patients after sleeve gastrectomy (SG).
• To assess the relationship between total weight loss (TWL) and HH development.
• To determine if HH predicts postoperative gastroesophageal reflux disease (GERD).

Main Methods:

• Retrospective review of a prospective database of patients undergoing laparoscopic SG (2013-2019).
• Analysis of patient demographics, weight loss, and comorbidity resolution.
• Assessment of HH and GERD at 5 years post-SG using statistical analysis (SAS 9.4, alpha=0.05).

Main Results:

• 10 out of 152 patients (6.6%) developed an HH post-SG.
• Higher total weight loss (TWL) at 1 and 3 years was associated with HH development.
• HH presence significantly predicted postoperative GERD (90% vs. 47.2%, P=.018).
• Preoperative GERD predicted postoperative HH; all HH cases required repair.

Conclusions:

• Patients with GERD and ~20% TWL at 5 years post-SG warrant evaluation for HH.
• Sleeve gastrectomy may be associated with an increased risk of hiatal hernia.
• Early detection and management of HH are crucial in SG patients with GERD.