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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

Predicted probability of PPI use.
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Figure 5: Predicted probability of PPI use.

Mentions: Regarding PPI use, Figure 5 shows the changes in the estimated average probability of PPI use during the 2 years after surgery. Before surgery, slightly more than 90% of the patients were on PPIs. The rate of usage decreased in the 2 years after surgery, at which time PPI use was roughly 60%. The odds of PPI use at 12 months were about one-fifth of those before surgery (P = .026). The odds of PPI use at 24 months were about one-tenth of those before surgery (P = .007). Finally, the odds of PPI use at 24 months were about half of those at 12 months, although the difference was not statistically significant (P = .15).


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)

Predicted probability of PPI use.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Predicted probability of PPI use.
Mentions: Regarding PPI use, Figure 5 shows the changes in the estimated average probability of PPI use during the 2 years after surgery. Before surgery, slightly more than 90% of the patients were on PPIs. The rate of usage decreased in the 2 years after surgery, at which time PPI use was roughly 60%. The odds of PPI use at 12 months were about one-fifth of those before surgery (P = .026). The odds of PPI use at 24 months were about one-tenth of those before surgery (P = .007). Finally, the odds of PPI use at 24 months were about half of those at 12 months, although the difference was not statistically significant (P = .15).

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