Effect of Concomitant Laparoscopic Sleeve Gastrectomy and Hiatal Hernia Repair on Gastroesophageal Reflux Disease in Patients with Obesity: a Systematic Review and Meta-analysis

Overview

Journal Obes Surg

Date 2021 Jul 13

PMID 34254259

Citations 8

Authors

Wenhui Chen

Jia Feng

Cunchuan Wang

Yucheng Wang

Wah Yang

Zhiyong Dong

Affiliations

Soon will be listed here.

Abstract

Background: Hiatal hernia repair (HHR) during sleeve gastrectomy (SG) is recommended when hiatal hernia (HH) is found intraoperatively. However, its effect on gastroesophageal reflux disease (GERD) remains controversial.

Objective: To evaluate the effect of concomitant SG and HHR on GERD in patients with obesity.

Methods: Web of Science, PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov databases were searched for all studies reporting the efficacy of SG+HHR for patients with obesity and GERD up to March 2021.

Results: A total of 18 studies totaling 937 patients met the inclusion criteria. The results of meta-analysis showed that after SG+HHR, there was a significant reduction in GERD symptoms (OR: 0.20; 95% CI: 0.10 to 0.41; P < 0.00001), improvement in esophagitis (OR: 0.12, 95% CI: 0.05 to 0.26, P < 0.001), and decrease in GERD-HRQL (MD: 19.13, 95% CI: -3.74 to 34.51; P=0.01). The incidence of GERD remission after SG+HHR was 68.0% (95% CI: 55.0-80.9%), de novo GERD was 12% (95% CI: 8-16%), and HH recurrence was 11% (95% CI: 4 to 19%). SG+HHR was superior to SG alone in GERD remission (OR: 2.97, 95% CI: 1.78 to 4.95, P < 0.0001). However, there was no significant difference in de novo GERD after SG+HHR compared with SG alone.

Conclusions: SG+HHR can positively affect weight loss, GERD resolution, esophagitis reduction, and GERD-HRQL improvement. SG+HHR seems to have a promising future in patients with obesity and GERD. However, further studies based on objective assessment are warranted to evaluate these results better.

Citing Articles

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Mills H, Alhindi Y, Idris I, Al-Khyatt W Obes Surg. 2023; 33(12):3755-3766.

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Reply to Letter to the Editor: Role of Preoperative High-Resolution Manometry in the Identification of Patients at High Risk of Postoperative GERD Symptoms 1 Year After Sleeve Gastrectomy.

Bonaldi M, Rubicondo C, Andreasi V, Giorgi R, Cesana G, Ciccarese F Obes Surg. 2023; 33(10):3309-3310.

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References

Angrisani L, Santonicola A, Iovino P, Vitiello A, Zundel N, Buchwald H . Bariatric Surgery and Endoluminal Procedures: IFSO Worldwide Survey 2014. Obes Surg. 2017; 27(9):2279-2289. PMC: 5562777. DOI: 10.1007/s11695-017-2666-x. View

Gagner M, Hutchinson C, Rosenthal R . Fifth International Consensus Conference: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2016; 12(4):750-756. DOI: 10.1016/j.soard.2016.01.022. View

Stenard F, Iannelli A . Laparoscopic sleeve gastrectomy and gastroesophageal reflux. World J Gastroenterol. 2015; 21(36):10348-57. PMC: 4579881. DOI: 10.3748/wjg.v21.i36.10348. View

Yeung K, Penney N, Ashrafian L, Darzi A, Ashrafian H . Does Sleeve Gastrectomy Expose the Distal Esophagus to Severe Reflux?: A Systematic Review and Meta-analysis. Ann Surg. 2019; 271(2):257-265. DOI: 10.1097/SLA.0000000000003275. View

Bevilacqua L, Obeid N, Yang J, Zhu C, Altieri M, Spaniolas K . Incidence of GERD, esophagitis, Barrett's esophagus, and esophageal adenocarcinoma after bariatric surgery. Surg Obes Relat Dis. 2020; 16(11):1828-1836. DOI: 10.1016/j.soard.2020.06.016. View

Braghetto I, Csendes A . Prevalence of Barrett's Esophagus in Bariatric Patients Undergoing Sleeve Gastrectomy. Obes Surg. 2015; 26(4):710-4. DOI: 10.1007/s11695-015-1574-1. View

Qumseya B, Qumsiyeh Y, Ponniah S, Estores D, Yang D, Johnson-Mann C . Barrett's esophagus after sleeve gastrectomy: a systematic review and meta-analysis. Gastrointest Endosc. 2020; 93(2):343-352.e2. DOI: 10.1016/j.gie.2020.08.008. View

Genco A, Castagneto-Gissey L, Lorenzo M, Ernesti I, Soricelli E, Casella G . Esophageal adenocarcinoma after sleeve gastrectomy: actual or potential threat? Italian series and literature review. Surg Obes Relat Dis. 2020; 17(5):848-854. DOI: 10.1016/j.soard.2020.11.023. View

Coleman H, Xie S, Lagergren J . The Epidemiology of Esophageal Adenocarcinoma. Gastroenterology. 2017; 154(2):390-405. DOI: 10.1053/j.gastro.2017.07.046. View

10.

Wilson L, Ma W, Hirschowitz B . Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol. 1999; 94(10):2840-4. DOI: 10.1111/j.1572-0241.1999.01426.x. View

11.

Che F, Nguyen B, Cohen A, Nguyen N . Prevalence of hiatal hernia in the morbidly obese. Surg Obes Relat Dis. 2013; 9(6):920-4. DOI: 10.1016/j.soard.2013.03.013. View

12.

Carabotti M, Avallone M, Cereatti F, Paganini A, Greco F, Scirocco A . Usefulness of Upper Gastrointestinal Symptoms as a Driver to Prescribe Gastroscopy in Obese Patients Candidate to Bariatric Surgery. A Prospective Study. Obes Surg. 2015; 26(5):1075-80. DOI: 10.1007/s11695-015-1861-x. View

13.

Ouyang W, Dass C, Zhao H, Kim C, Criner G . Multiplanar MDCT measurement of esophageal hiatus surface area: association with hiatal hernia and GERD. Surg Endosc. 2015; 30(6):2465-72. PMC: 4767697. DOI: 10.1007/s00464-015-4499-9. View

14.

Koch O, Schurich M, Antoniou S, Spaun G, Kaindlstorfer A, Pointner R . Predictability of hiatal hernia/defect size: is there a correlation between pre- and intraoperative findings?. Hernia. 2013; 18(6):883-8. DOI: 10.1007/s10029-012-1033-z. View

15.

Pomp A . Comment on: sleeve gastrectomy and crural repair in obese patients with gastroesophageal reflux disease and/or hiatal hernia. Surg Obes Relat Dis. 2012; 9(3):361-2. DOI: 10.1016/j.soard.2012.07.011. View

16.

Arnoldner M, Felsenreich D, Langer F, Weber M, Mang T, Kulinna-Cosentini C . Pouch volume and pouch migration after Roux-en-Y gastric bypass: a comparison of gastroscopy and 3 D-CT volumetry: is there a "migration crisis"?. Surg Obes Relat Dis. 2020; 16(12):1902-1908. DOI: 10.1016/j.soard.2020.07.024. View

17.

Soricelli E, Iossa A, Casella G, Abbatini F, Cali B, Basso N . Sleeve gastrectomy and crural repair in obese patients with gastroesophageal reflux disease and/or hiatal hernia. Surg Obes Relat Dis. 2012; 9(3):356-61. DOI: 10.1016/j.soard.2012.06.003. View

18.

Diaz A, Arvidsson D, Baker R, Basso N, Bellanger D, Boza C . International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012; 8(1):8-19. DOI: 10.1016/j.soard.2011.10.019. View

19.

Dakour Aridi H, Tamim H, Mailhac A, Safadi B . Concomitant hiatal hernia repair with laparoscopic sleeve gastrectomy is safe: analysis of the ACS-NSQIP database. Surg Obes Relat Dis. 2016; 13(3):379-384. DOI: 10.1016/j.soard.2016.09.037. View

20.

Janik M, Ibikunle C, Aryaie A . Safety of concurrent sleeve gastrectomy and hiatal hernia repair: a propensity score-matched analysis of the MBSAQIP registry. Surg Obes Relat Dis. 2020; 16(3):365-371. DOI: 10.1016/j.soard.2019.12.003. View