I have a morbidly obese patient who is due for a gastric bypass. He also has severe GERD due to a hiatus hernia. I know that reflux symptoms improve just by doing the bypass and weight loss thereafter. So is there a need to perform a formal hiatal hernia repair for him along with the gastric bypass?
Hi, gastric bapyss is the perfect procedure for obesity and reflux disease. The hiatal hernia itself is not an indication for surgery.
PErforming a hiatal hernia repair before gastric bypass would render the bypass more risky.
Thanks Dr. Miholicc. I meant to perform the hiatal hernia repair DURING the gastric bypass surgery - in the same sitting.
hi. it is depend on the size of hernia, if it is more than 4cm its preferable to do it.
https://www.google.iq/url?sa=t&source=web&rct=j&url=https://www.sages.org/publications/guidelines/guidelines-for-the-management-of-hiatal-hernia/&ved=2ahUKEwj3lrP30c_ZAhULI8AKHQcBDNoQFjACegQIARAB&usg=AOvVaw2yly8ShXM9YuHwLJhKq2al
Dear Sir
There is evidence that crural approximation reduces the chance of postop GERD in obese patients with hiatal hernia and GERD.
Hiatal Hernia Repair in Laparoscopic Roux-en-Y Gastric Bypass Significantly Improves Reflux But Not Weight Loss Daniel Moon, MD, Ahmad Bashir, MD, Jennifer Higa, BS MPH, Saber Ghiassi, MD MPH, Tienchin Ho, MD FACS, Keith Boone, MD FACS, Kelvin Higa, MD FACS. Department of Surgery, UCSF- Fresno Medical Education Program
I always repair it, during gastric bypass procedure, if a paraesophageal hernia is detected.
When sleeve gastrectomy patients develop severe GERD, we use to perform a gastric bypass with posterior crural approximation.
So YES, I would repair it
Thanks very much Dr. Tomas, that answer is exactly what I was looking for.
Probably advisable for a number of reasons. Firstly reflux symptoms likely to be better (and if you know you have repaired the hernia then the need for further revisions surgery is diminished). Secondly if the hernia is sizeable, reducing the stomach will allow you to get a better sized small gastric pouch which in theory should be a better bariatric operation. Thirdly you dont want the pouch / roux Gastro jej disappearing into a hiatus hernia and although relatively rare, approximating the hiatus should reduce the chances of this