Incidence of de Novo Hiatal Hernia after Laparoscopic Sleeve Gastrectomy
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ORIGINAL CONTRIBUTIONS
Incidence of de Novo Hiatal Hernia after Laparoscopic Sleeve Gastrectomy Jorge Saba 1,2,3
&
Magdalena Bravo 4 & Eugenio Rivas 1 & Roberto Fernández 1 & Alberto Pérez-Castilla 1 & Jorge Zajjur 1
Received: 5 January 2020 / Revised: 23 May 2020 / Accepted: 28 May 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose After laparoscopic sleeve gastrectomy (LSG), several studies have reported an increase in the incidence of gastroesophageal reflux (GERD). The etiopathogenesis of GERD post-LSG is multifactorial, and hiatal hernia (HH) is one of them. The primary objective was to measure the incidence of de novo HH post-LSG. The secondary objectives were to relate the presence of HH with GERD, the chronic use of proton pump inhibitors (PPI), and the time elapsed from LSG. Materials and Methods A surgical evaluation of the crura after LSG was performed. A retrospective cohort study of 74 consecutive patients with history of LSG submitted to an intra-abdominal surgery that allowed the evaluation of the crura. Results Of a total of 74 patients, 51 were included. At the time of surgery, 37 patients (72.5%) had a HH; 24 patients (47.1%) had GERD, and 23 patients (45.1%) were frequently using PPI. When patients with HH and those without HH were compared, GERD was observed in 56.8% versus 21.4% (p = 0.01) and frequent consumption on PPI was found in 54.1% versus 21.4% (p = 0.02). According to the data of LSG, with a follow-up of < 18 months, 60% presented HH; meanwhile, with a follow-up of > 18 months, 84.6% presented HH (p = 0.02). Conclusions Patients submitted to LSG showed a high incidence of de novo HH. HH was associated with a higher incidence of GERD and PPI dependence. The longer the time elapsed from the LSG, the greater the incidence of HH. Keywords Sleeve gastrectomy . Hiatal hernia . Gastroesophageal reflux
Introduction Laparoscopic sleeve gastrectomy (LSG) is currently the most widely used procedure in the surgical treatment of obesity [1], owing to its safety, technical simplicity, and effectiveness [2, 3]. However, among its most frequently described postoperative complications is de novo gastroesophageal reflux disease (GERD), with an occurrence rate of between 2.1 and 47.2% [4, 5]. GERD considerably deteriorates the quality of
* Jorge Saba [email protected] 1
Service of Bariatric and Metabolic Surgery, Indisa Clinic, Avenida Santa María 1810, 7520440 Santiago, Chile
2
Surgery Service, Dipreca Hospital, Avenida Vital Apoquindo 1200, 7601003 Santiago, Chile
3
School of Medicine, Diego Portales University, Dipreca Hospital, Avenida Vital Apoquindo 1200, 7601003 Santiago, Chile
4
Surgery Service, Luis Tisné Hospital, Avenida Las Torres 5150, 7930124 Santiago, Chile
life of patients and leads to multiple complications, such as erosive esophagitis, bleeding, stenosis, Barrett’s esophagus, and esophageal cancer. Multiple mechanisms that could induce de novo GERD after LSG have been described, including reduction of the lower esophageal sphincte
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