Hiatal reconstruction safe and effective for control of reflux after laparoscopic sleeve gastrectomy

Gastroesophageal reflux is a known complication following laparoscopic sleeve gastrectomy (LSG) as anatomical changes predispose to reduced lower oesophagal sphincter pressure and development of hiatus hernia. The mainstay of surgical management has been Roux-en-Y gastric bypass (RYGB) which is not without risk. Hiatus hernia repair (HHR) with surgical reattachment of the oesophagus to the crura, recreating the phreno-oesophagal ligament is a simple procedure specifically targeting a number of anatomical changes responsible for reflux in this population.

They conducted a single centre retrospective analysis of adult patients with post-sleeve reflux refractory to medical treatment, managed with either HHR, RYGB or One-anastomosis Duodenal switch (OADS). PPI use and symptoms of reflux were assessed at early and mid-term time points via validated questionnaires.

Results

• 99 patients were included, of these, the surgical procedure was HHR alone in 58, RYGB in 29 and OADS in 12.
• At early follow-up control of reflux symptoms was achieved in 72.4% after HHR, 82.1% after RYGB and 100% after OADS with no significant difference between groups
• At mid-term follow-up (median 10 months IQR 7–21) there was no significant difference in the presence of symptomatic reflux as determined by post-op Visick score nor a difference in PPI use. The GerdQ score was significantly lower after OADS as compared to HHR and RYGB

Thus, HHR with the reconstruction of the phreno-oesophagal ligament is a safe and effective procedure for patients with reflux after laparoscopic sleeve gastrectomy, that avoids more complex operations such as RYGB and OADS and their associated long-term sequelae.

Reference:

Indja, B., Chan, D.L. & Talbot, M.L. Hiatal reconstruction is safe and effective for control of reflux after laparoscopic sleeve gastrectomy. BMC Surg 22, 347 (2022). https://doi.org/10.1186/s12893-022-01800-y