Limits...
Paraesophageal Hernia Repair With Partial Longitudinal Gastrectomy in Obese Patients.

Davis M, Rodriguez J, El-Hayek K, Brethauer S, Schauer P, Zelisko A, Chand B, O'Rourke C, Kroh M - JSLS (2015 Jul-Sep)

Bottom Line: At 1 year, symptom scores decreased significantly.At 27 months, however, there was a mild increase in the scores.Short-term results were promising; however, intermediate results showed increasing rates of reflux symptoms that required medical therapy or conversion to gastric bypass.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Digestive Disease Institute.

ABSTRACT

Background and objectives: Treatment of gastroesophageal reflux disease (GERD) with hiatal hernia in obese patients has proven difficult, as studies demonstrate poor symptom control and high failure rates in this patient population. Recent data have shown that incorporating weight loss procedures into the treatment of reflux may improve overall outcomes.

Methods: We retrospectively reviewed 28 obese and morbidly obese patients who presented from December 2007 through July 2013 with large or recurrent type 3 or 4 paraesophageal hernia. All of the patients underwent combined paraesophageal hernia repair and partial longitudinal gastrectomy. Charts were retrospectively reviewed, and the patients were contacted to determine symptomatic relief.

Results: Mean preoperative body mass index was 38.1 ± 4.9 kg/m(2). Anatomic failure of prior fundoplication occurred in 7 patients (25%). The remaining 21 had primary paraesophageal hernia, 3 of which were type 4. Postoperative complications included pulmonary embolism (n = 1), pulmonary decompensation (n = 2), and wound infection (n = 1). Mean hospital stay was 5 ± 3 days. Upper gastrointestinal esophagogram was performed in 21 patients with no immediate recurrence or staple line dehiscence. Mean excess weight loss was 44 ± 25%. All of the patients surveyed experienced near to total resolution of their preoperative symptoms within the first month. At 1 year, symptom scores decreased significantly. At 27 months, however, there was a mild increase in the scores. Return of severe symptoms occurred in 2 patients, both of whom underwent conversion to gastric bypass.

Conclusions: Combined laparoscopic paraesophageal hernia repair with longitudinal partial gastrectomy offers a safe, feasible approach to the management of large or recurrent paraesophageal hernia in well-selected obese and morbidly obese patients. Short-term results were promising; however, intermediate results showed increasing rates of reflux symptoms that required medical therapy or conversion to gastric bypass.

No MeSH data available.


Related in: MedlinePlus

Average symptom score over the 2-year follow-up.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4591904&req=5

Figure 3: Average symptom score over the 2-year follow-up.

Mentions: The results after the mean follow-up period of 27 months (range, 5–46) are summarized in Table 2. The symptom severity index (0–21) was calculated for all 21 patients. Before surgery, the patients had a mean score of 15 ± 5 (range, 2–21). The mean postoperative symptom severity index was 6 ± 5 (range, 0–20). Surgery also was effective in reducing the use of daily antisecretory medications (PPIs/H2-blockers), from 96% (before surgery) to 62% (at the time of the survey). The average score at 12 months was about one-tenth of the average score before surgery, and the average score at 24 months was approximately one-fifth of the average score before surgery (both P < .001). The average score at 24 months was estimated to be about twice the average score at 12 months, but the difference was not statistically significant (P = .23). Figure 3 gives the average score as estimated by the model for a 2-year follow-up time. After a fairly precipitous drop during the ∼6 months after surgery, the average score did not seem to change appreciably or increased slightly.


Paraesophageal Hernia Repair With Partial Longitudinal Gastrectomy in Obese Patients.

Davis M, Rodriguez J, El-Hayek K, Brethauer S, Schauer P, Zelisko A, Chand B, O'Rourke C, Kroh M - JSLS (2015 Jul-Sep)

Average symptom score over the 2-year follow-up.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4591904&req=5

Figure 3: Average symptom score over the 2-year follow-up.
Mentions: The results after the mean follow-up period of 27 months (range, 5–46) are summarized in Table 2. The symptom severity index (0–21) was calculated for all 21 patients. Before surgery, the patients had a mean score of 15 ± 5 (range, 2–21). The mean postoperative symptom severity index was 6 ± 5 (range, 0–20). Surgery also was effective in reducing the use of daily antisecretory medications (PPIs/H2-blockers), from 96% (before surgery) to 62% (at the time of the survey). The average score at 12 months was about one-tenth of the average score before surgery, and the average score at 24 months was approximately one-fifth of the average score before surgery (both P < .001). The average score at 24 months was estimated to be about twice the average score at 12 months, but the difference was not statistically significant (P = .23). Figure 3 gives the average score as estimated by the model for a 2-year follow-up time. After a fairly precipitous drop during the ∼6 months after surgery, the average score did not seem to change appreciably or increased slightly.

Bottom Line: At 1 year, symptom scores decreased significantly.At 27 months, however, there was a mild increase in the scores.Short-term results were promising; however, intermediate results showed increasing rates of reflux symptoms that required medical therapy or conversion to gastric bypass.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Digestive Disease Institute.

ABSTRACT

Background and objectives: Treatment of gastroesophageal reflux disease (GERD) with hiatal hernia in obese patients has proven difficult, as studies demonstrate poor symptom control and high failure rates in this patient population. Recent data have shown that incorporating weight loss procedures into the treatment of reflux may improve overall outcomes.

Methods: We retrospectively reviewed 28 obese and morbidly obese patients who presented from December 2007 through July 2013 with large or recurrent type 3 or 4 paraesophageal hernia. All of the patients underwent combined paraesophageal hernia repair and partial longitudinal gastrectomy. Charts were retrospectively reviewed, and the patients were contacted to determine symptomatic relief.

Results: Mean preoperative body mass index was 38.1 ± 4.9 kg/m(2). Anatomic failure of prior fundoplication occurred in 7 patients (25%). The remaining 21 had primary paraesophageal hernia, 3 of which were type 4. Postoperative complications included pulmonary embolism (n = 1), pulmonary decompensation (n = 2), and wound infection (n = 1). Mean hospital stay was 5 ± 3 days. Upper gastrointestinal esophagogram was performed in 21 patients with no immediate recurrence or staple line dehiscence. Mean excess weight loss was 44 ± 25%. All of the patients surveyed experienced near to total resolution of their preoperative symptoms within the first month. At 1 year, symptom scores decreased significantly. At 27 months, however, there was a mild increase in the scores. Return of severe symptoms occurred in 2 patients, both of whom underwent conversion to gastric bypass.

Conclusions: Combined laparoscopic paraesophageal hernia repair with longitudinal partial gastrectomy offers a safe, feasible approach to the management of large or recurrent paraesophageal hernia in well-selected obese and morbidly obese patients. Short-term results were promising; however, intermediate results showed increasing rates of reflux symptoms that required medical therapy or conversion to gastric bypass.

No MeSH data available.


Related in: MedlinePlus