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Simultaneous laparoscopic paraesophageal hernia repair and sleeve gastrectomy in the morbidly obese.
Surg Obes Relat Dis. 2014 Mar-Apr; 10(2):257-61.SO

Abstract

BACKGROUND

Morbid obesity is associated with increased rates of hiatal and paraesophageal hernias. Although laparoscopic sleeve gastrectomy is gaining popularity as the procedure of choice for morbid obesity, there is little data regarding the management of paraesophageal hernias found intraoperatively. The aim of this study was to evaluate the feasibility and benefits of a combined sleeve gastrectomy and paraesophageal hernia repair in morbidly obese patients.

METHODS

From May 2011 to February 2013, 23 patients underwent laparoscopic sleeve gastrectomy combined with the repair of a paraesophageal hernia. Only 4 patients had a large hiatal hernia documented preoperatively on esophagogastroduodenoscopy (EGD). The body mass index (BMI), operative time, length of stay, and complications were evaluated.

RESULTS

The average operative time was 165 minutes (115-240 minutes) and length of stay was 2.83 days (2-6 days). All patients were female except for one, with an average age of 53.4 years and a BMI of 41.9 kg/m(2). There were no complications during the procedures. Mean follow-up was 6.16 months (1-19 months), and mean excess weight loss was 39%. The average cost of admission for a combined procedure ($10,056), was slightly higher than a laparoscopic sleeve gastrectomy ($8905) or laparoscopic paraesophageal hernia repair ($8954) done separately.

CONCLUSIONS

Laparoscopic sleeve gastrectomy combined with a paraesophageal hernia repair is well-tolerated and feasible in morbidly obese patients. Surgeons should be aware that preoperative EGD is not effective at diagnosing large hiatal or paraesophageal hernias. Surgeons with the skill set to repair paraesophageal hernias should do a combined procedure because it is well-tolerated, feasible, and can reduce the cost of multiple hospital admissions.

Authors+Show Affiliations

Department of Surgery, Monmouth Medical Center, Long Branch, New Jersey. Electronic address: dpham@barnabashealth.org.Department of Surgery, Monmouth Medical Center, Long Branch, New Jersey.Department of Surgery, Monmouth Medical Center, Long Branch, New Jersey.Department of Surgery, Monmouth Medical Center, Long Branch, New Jersey.Department of Surgery, Monmouth Medical Center, Long Branch, New Jersey.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24209882

Citation

Pham, David V., et al. "Simultaneous Laparoscopic Paraesophageal Hernia Repair and Sleeve Gastrectomy in the Morbidly Obese." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 10, no. 2, 2014, pp. 257-61.
Pham DV, Protyniak B, Binenbaum SJ, et al. Simultaneous laparoscopic paraesophageal hernia repair and sleeve gastrectomy in the morbidly obese. Surg Obes Relat Dis. 2014;10(2):257-61.
Pham, D. V., Protyniak, B., Binenbaum, S. J., Squillaro, A., & Borao, F. J. (2014). Simultaneous laparoscopic paraesophageal hernia repair and sleeve gastrectomy in the morbidly obese. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 10(2), 257-61. https://doi.org/10.1016/j.soard.2013.08.003
Pham DV, et al. Simultaneous Laparoscopic Paraesophageal Hernia Repair and Sleeve Gastrectomy in the Morbidly Obese. Surg Obes Relat Dis. 2014 Mar-Apr;10(2):257-61. PubMed PMID: 24209882.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Simultaneous laparoscopic paraesophageal hernia repair and sleeve gastrectomy in the morbidly obese. AU - Pham,David V, AU - Protyniak,Bogdan, AU - Binenbaum,Steven J, AU - Squillaro,Anthony, AU - Borao,Frank J, Y1 - 2013/08/23/ PY - 2013/03/13/received PY - 2013/06/18/revised PY - 2013/08/10/accepted PY - 2013/11/12/entrez PY - 2013/11/12/pubmed PY - 2014/12/15/medline KW - Laparoscopic sleeve gastrectomy KW - Roux-en-Y gastric bypass KW - adjustable gastric band KW - bariatric surgery KW - hiatal hernia KW - hiatal hernia repair KW - obesity KW - paraesophageal hernia KW - paraesophageal hernia repair SP - 257 EP - 61 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 10 IS - 2 N2 - BACKGROUND: Morbid obesity is associated with increased rates of hiatal and paraesophageal hernias. Although laparoscopic sleeve gastrectomy is gaining popularity as the procedure of choice for morbid obesity, there is little data regarding the management of paraesophageal hernias found intraoperatively. The aim of this study was to evaluate the feasibility and benefits of a combined sleeve gastrectomy and paraesophageal hernia repair in morbidly obese patients. METHODS: From May 2011 to February 2013, 23 patients underwent laparoscopic sleeve gastrectomy combined with the repair of a paraesophageal hernia. Only 4 patients had a large hiatal hernia documented preoperatively on esophagogastroduodenoscopy (EGD). The body mass index (BMI), operative time, length of stay, and complications were evaluated. RESULTS: The average operative time was 165 minutes (115-240 minutes) and length of stay was 2.83 days (2-6 days). All patients were female except for one, with an average age of 53.4 years and a BMI of 41.9 kg/m(2). There were no complications during the procedures. Mean follow-up was 6.16 months (1-19 months), and mean excess weight loss was 39%. The average cost of admission for a combined procedure ($10,056), was slightly higher than a laparoscopic sleeve gastrectomy ($8905) or laparoscopic paraesophageal hernia repair ($8954) done separately. CONCLUSIONS: Laparoscopic sleeve gastrectomy combined with a paraesophageal hernia repair is well-tolerated and feasible in morbidly obese patients. Surgeons should be aware that preoperative EGD is not effective at diagnosing large hiatal or paraesophageal hernias. Surgeons with the skill set to repair paraesophageal hernias should do a combined procedure because it is well-tolerated, feasible, and can reduce the cost of multiple hospital admissions. SN - 1878-7533 UR - https://www.unboundmedicine.com/medline/citation/24209882/Simultaneous_laparoscopic_paraesophageal_hernia_repair_and_sleeve_gastrectomy_in_the_morbidly_obese_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(13)00248-7 DB - PRIME DP - Unbound Medicine ER -