Initial Experience of Laparoscopic Crural Closure in the Management of Hiatal Hernia in Obese Patients Undergoing Sleeve Gastrectomy

Document Type : Original Article

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Department of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

Abstract

Background: Laparoscopic Sleeve Gastrectomy [LSG] has made a revolution in the surgical treatment of obese patients, but only a few studies evaluated the concomitant repair of Hiatus Hernia [HH] during LSG, in obese patients with HH.
Aim: This study aimed to evaluate the safety and effectiveness of combined LSG with Crural repair in obese patients with HH.
Methods: This is a prospective study that was applied to 20 obese patients who underwent LSG with a crural repair. Preoperative data collected included personal, medical, and surgical history, clinical and endoscopic examination, intraoperative time and difficulties, postoperative data included hospital stay, postoperative complication, body mass index [BMI], and endoscopic evaluation.
Results: The mean age of the patients was 42.4±5.4 years old. The majority of the patients were females [70%] and only 30% were males. The mean of their BMI was 44.6±4.69 Kg/m2. There was a statistically significant reduction in preoperative BMI measures [44.6±4.5766 kg/m2] 6 months postoperatively measures [33.95±3.499 kg/m2] [P value 0 .0001]. The simultaneous crural repair in the treatment of morbid obesity associated with HH led to symptomatic relief of GERD in 75% of the patients. Only one patient [5%] developed a recurrence of HH in endoscopic evaluation. There were no recorded intraoperative or postoperative complications, and all patients' quality of life was enhanced.
Conclusion: Combined LSG with a crural repair is one of the most accepted procedures in the management of obese patients with HH with a high degree of safety and effectiveness.

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