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    • Sleeve Gastrectomy with Hiatus Hernia Repair in 25 Egyptian Morbid Obese : Short Term Results

    Karim Sabry (MD, MRCS) , Wael A Jumuah (MD) ,Yasser El Ghamrini (MD)
    Department of General Surgery, Faculty of Medicine, Cairo University

    Background: Obesity is considered one of the risk factors for gastroesophageal reflux disease and hiatal hernia and severity of reflux symptoms in presence of obesity lead to a decrease in the quality of life. Treatment of obese patients with gastroesophageal reflux disease (GERD) and hiatal hernia (HH)has proven difficult due to poor symptom control and high failure rates in this patient population , recent studies have shown that incorporating weight loss procedures into the treatment of reflux may improve overall outcomes. Identification of HH during SG (sleeve gastrectomy) and the effect of its repair on GERD related symptoms are controversial. Objective: This study aimed to evaluate the effect of concomitant HHR (hiatal hernia repair) in morbidly obese patients undergoing LSG and its short term effect on resolution or persistence of GERD related symptoms, other clinical outcomes and complication rates. Patients and methods: A total number of 25 patients suffering from morbid obesity and hiatus hernia were operated for simultaneous laparoscopic sleeve gastrectomy with hiatal hernia repair at the department of general surgery at El Demardash Hospital at Ain Shams University in Cairo, Egypt from January 2014 to December 2016. Results: In our retrospective study data obtained from patients interpreted as a chart review that was conducted with a mean follow up of 7 months. The mean weight was 128kg , BMI of 44 , average weight loss of 6.4kg/month. 19/25 patients had pre-operative diagnosis of HH with 16 of them complained of GERD symptoms. 6/25 patient without symptoms showed no evidence of HH on UGI and did not have a pre-operative EGD but a HH was identified intra-operatively. Crural closure was performed in all cases with HH size ranging from 2cm to 5cm. 16/25 (64%) patients who had symptomatic reflux reported cessation of symptoms post-operative. 7 of 10 (70%) patients who was taking anti-reflux medication before surgery discontinued all medication and the other 3 patients, although reported decrease in symptoms still continued to take proton pump inhibitors. Conclusions: With the increase risk of reflux before weight loss surgery as well as after LSG, patients with HH identified pre-operative and intraoperative should be considered for repair, Combination LSG with HHR is safe and provides good outcomes for patients with morbid obesity and GERD. Keywords: Sleeve Gastrectomy, Hiatal Hernia.

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