You are using an old and unsupported browser. Most core functionality will not work. Please upgrade to a supported browser - Google Chrome

ANZMOSS - ANZGOSA 2020 Virtual Conference
ANZMOSS – ANZGOSA 2020 Virtual Conference
ANZMOSS - ANZGOSA 2020 Virtual Conference
Home
Streams

Hiatal hernia repair is non-inferior to bypass in the treatment of post-sleeve reflux

Featured
Description
BACKGROUND
Gastroesophageal reflux is a known complication following laparoscopic sleeve gastrectomy (LSG) as the anatomical and physiological changes predispose to reduced lower oesophageal sphincter pressure, increased intragastric pressure and development of hiatus hernia. In patients whose symptoms do not respond to medical therapy, the mainstay of surgical management has been conversion to a Roux-en-Y gastric bypass (RYGB), however this procedure it not without its own risks. Hiatus hernia repair (HHR) is a simple procedure that can specifically target a number of the anatomical changes responsible for reflux in this population.
 
METHOD
We conducted a single centre retrospective analysis including 84 adult patients with prior LSG presenting with gastroesophageal reflux refractory to medical therapy. 
 
RESULTS
49 patients underwent HHR, 30 patients had a RYGB (4 with prior HHR) and 11 underwent one anastomosis duodenal switch (OADS) (2 with prior HHR). With a median follow-up of 9 months (IQR 1-25), control of reflux symptoms after surgery was achieved in 71.4% after HHR, 86.7% after RYGB and 90.9% after OADS with no significant difference demonstrated between each group (p=0.24). Of the patients who achieved symptom control 46% (HHR), 34.6% (RYGB) and 40% (OADS) remained off PPI while the remainder required regular or breakthrough PPI for ongoing control (p=0.48).
 
CONCLUSION
HHR may be a safe and effective initial surgical option for patients presenting with reflux following LSG, that provides similar outcomes to more complex operations such as RYGB and DS.
Authors
Daniel Chan - UNSW, Michael Talbot - Upper GI surgery, St George public and private hospitals, and Ben Indja - St George Hospital
Other Suggested Sessions Presentations