Introduction Persistent, worse, or new symptoms of gastroesophageal reflux disease (GORD) are common after laparoscopic sleeve gastrectomy (SG) and can be associated with the presence of a hiatus hernia (HH). This study aimed to assess the effectiveness of HH repair for the management of GORD symptoms after SG.
Methods We conducted a retrospective and prospective study on patients who underwent HH repair as an independent operation after SG. The primary outcome was GORD symptom severity measured using a structured symptom questionnaire (SSQ, total range 0-7). Secondary outcomes included changes in weight and obesity-related health problems and the need for further GORD treatment.
Results Twenty-five patients underwent HH repair after SG; all were available for follow-up (median 37 months, range 14-111 months). HH repair improved overall GORD symptoms: median SSQ score pre-HH repair 4 vs 1 post HH repair (p<0.001). For five patients, GORD symptoms returned after HH repair, on average, within four years; these patients underwent Roux-en-Y gastric bypass (RYGB).
HH repair improved GORD score in 18 (72%). Complete relief of all GORD symptoms occurred in 10 (40%), of whom 1 (4%) were taking daily PPI therapy and 4 (16%) were taking some acid suppression medical therapy as needed.
Conclusion HH repair post SG adequately controlled GORD symptoms in most patients in this study. Severe reflux persists in a minority of patients who are unable to avoid conversion to the RYGB.