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Initial Experience with Laparoscopic Crural Closure in the Management of Hiatal Hernia in Obese Patients Undergoing Sleeve Gastrectomy

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Abstract

Background

The prevalence of gastroesophageal reflux disease (GERD) and/or hiatal hernia (HH) is significantly increased in morbidly obese patients. Laparoscopic bariatric procedures such as gastric banding (LGB) and Roux-en-Y gastric bypass have been shown to improve both obesity and reflux symptoms. The aim of this paper is to evaluate the effectiveness of laparoscopic sleeve gastrectomy (LSG) and hiatal hernia repair (HHR) for the treatment of obesity complicated by HH.

Methods

From October 2008, six patients underwent HHR in addition to LSG. Clinical outcomes have been evaluated in terms of GERD symptoms improvement or resolution, interruption of antireflux medication, and X-ray evidence of HH recurrence.

Results

Symptomatic HH was diagnosed preoperatively in four patients. In two additional patients, HH was asymptomatic and it was diagnosed intraoperatively. Prosthetic reinforcement of crural closure was performed in two symptomatic cases with a HH >5 cm. Mortality was nil and no complications occurred. After a mean follow-up of 4 months, GERD symptoms resolution occurred in three patients, while the other patient reported an improvement of reflux. Body mass index had fallen from 43.4 to 36.2 kg/m2. A small recurrence in the patient with persistence of reflux symptoms has been radiologically reported.

Conclusions

Laparoscopic crural closure in addition to LSG could represent a valuable option for the synchronous management of morbid obesity and HH, providing good outcomes in terms of weight loss and GERD symptoms control.

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Authors and Affiliations

  1. Surgical-Medical Department for Digestive Diseases, Policlinico “Umberto I”, University “Sapienza”, Viale del Policlinico, 00161, Rome, Italy

    Emanuele Soricelli, Giovanni Casella, Mario Rizzello, Benedetto Calì, Giorgio Alessandri & Nicola Basso

Authors
  1. Emanuele Soricelli
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  2. Giovanni Casella
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  3. Mario Rizzello
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  4. Benedetto Calì
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  5. Giorgio Alessandri
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  6. Nicola Basso
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Correspondence to Nicola Basso.

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The authors have no conflict of interest.

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Soricelli, E., Casella, G., Rizzello, M. et al. Initial Experience with Laparoscopic Crural Closure in the Management of Hiatal Hernia in Obese Patients Undergoing Sleeve Gastrectomy. OBES SURG 20, 1149–1153 (2010). https://doi.org/10.1007/s11695-009-0056-8

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  • DOI: https://doi.org/10.1007/s11695-009-0056-8

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