Laparoscopic Roux-en-Y gastric bypass for treatment of symptomatic paraesophageal hernia in the morbidly obese: Medium-term results

Umer I. Chaudhry, Brendan M. Marr, Sylvester N. Osayi, Dean J. Mikami, Bradley J. Needleman, W. Scott Melvin, Kyle A. Perry

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background The ideal surgical approach for treatment of symptomatic paraesophageal hernias (PEH) in obese patients remains elusive. The objective of this study was to assess the safety, feasibility, and effectiveness of combined laparoscopic PEH repair and Roux-en-Y gastric bypass (RYGB) for the management of symptomatic PEH in morbidly obese patients.

Methods Fourteen patients with symptomatic PEH and morbid obesity (body mass index [BMI]>35 kg/m2) underwent laparoscopic PEH repair with RYGB between 2008 and 2011. Demographic characteristics and preoperative and perioperative details were analyzed. Patients were contacted in October 2013 for follow-up. BMI, reflux symptoms, and disease-specific quality of life (QoL) data were obtained.

Results There were 11 females (79%). Median age and preoperative BMI were 48 years and 42 kg/m2, respectively. Mean operative time was 180 minutes, with median length-of-stay of 4 days. There were no perioperative deaths, and 5 patients experienced postoperative complications including 1 gastrojejunostomy leak. Complete follow-up with a median follow-up interval of 35 months was available in 9 (64%) patients. The median % excess weight loss was 67.9%. Thirty-three percent required antisecretory medications for reflux control, compared to 89% preoperatively. Seventy-eight percent of patients reported good to excellent QoL outcomes assessed by the Gastroesophageal Reflux Disease Health-Related Quality of Life questionnaire. Overall, 89% of patients were satisfied with their operation and would undergo the procedure again.

Conclusion Combined laparoscopic PEH repair and RYGB is a safe, feasible, and effective treatment option for morbidly obese patients with symptomatic PEH, and offers good to excellent disease-specific quality-of-life outcomes at medium-term follow-up. To date, this is the largest series with the longest follow-up in this unique patient population.

Original languageEnglish (US)
Pages (from-to)1063-1069
Number of pages7
JournalSurgery for Obesity and Related Diseases
Volume10
Issue number6
DOIs
StatePublished - Nov 1 2014
Externally publishedYes

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Hiatal Hernia
Gastric Bypass
Herniorrhaphy
Quality of Life
Therapeutics
Body Mass Index
Morbid Obesity
Operative Time
Gastroesophageal Reflux
Weight Loss
Length of Stay
Demography
Safety

Keywords

  • Laparoscopy
  • Morbid obesity
  • Paraesophageal hernia
  • Roux-en-Y gastric bypass

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Laparoscopic Roux-en-Y gastric bypass for treatment of symptomatic paraesophageal hernia in the morbidly obese : Medium-term results. / Chaudhry, Umer I.; Marr, Brendan M.; Osayi, Sylvester N.; Mikami, Dean J.; Needleman, Bradley J.; Melvin, W. Scott; Perry, Kyle A.

In: Surgery for Obesity and Related Diseases, Vol. 10, No. 6, 01.11.2014, p. 1063-1069.

Research output: Contribution to journalArticle

Chaudhry, Umer I. ; Marr, Brendan M. ; Osayi, Sylvester N. ; Mikami, Dean J. ; Needleman, Bradley J. ; Melvin, W. Scott ; Perry, Kyle A. / Laparoscopic Roux-en-Y gastric bypass for treatment of symptomatic paraesophageal hernia in the morbidly obese : Medium-term results. In: Surgery for Obesity and Related Diseases. 2014 ; Vol. 10, No. 6. pp. 1063-1069.
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abstract = "Background The ideal surgical approach for treatment of symptomatic paraesophageal hernias (PEH) in obese patients remains elusive. The objective of this study was to assess the safety, feasibility, and effectiveness of combined laparoscopic PEH repair and Roux-en-Y gastric bypass (RYGB) for the management of symptomatic PEH in morbidly obese patients.Methods Fourteen patients with symptomatic PEH and morbid obesity (body mass index [BMI]>35 kg/m2) underwent laparoscopic PEH repair with RYGB between 2008 and 2011. Demographic characteristics and preoperative and perioperative details were analyzed. Patients were contacted in October 2013 for follow-up. BMI, reflux symptoms, and disease-specific quality of life (QoL) data were obtained.Results There were 11 females (79{\%}). Median age and preoperative BMI were 48 years and 42 kg/m2, respectively. Mean operative time was 180 minutes, with median length-of-stay of 4 days. There were no perioperative deaths, and 5 patients experienced postoperative complications including 1 gastrojejunostomy leak. Complete follow-up with a median follow-up interval of 35 months was available in 9 (64{\%}) patients. The median {\%} excess weight loss was 67.9{\%}. Thirty-three percent required antisecretory medications for reflux control, compared to 89{\%} preoperatively. Seventy-eight percent of patients reported good to excellent QoL outcomes assessed by the Gastroesophageal Reflux Disease Health-Related Quality of Life questionnaire. Overall, 89{\%} of patients were satisfied with their operation and would undergo the procedure again.Conclusion Combined laparoscopic PEH repair and RYGB is a safe, feasible, and effective treatment option for morbidly obese patients with symptomatic PEH, and offers good to excellent disease-specific quality-of-life outcomes at medium-term follow-up. To date, this is the largest series with the longest follow-up in this unique patient population.",
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T1 - Laparoscopic Roux-en-Y gastric bypass for treatment of symptomatic paraesophageal hernia in the morbidly obese

T2 - Medium-term results

AU - Chaudhry, Umer I.

AU - Marr, Brendan M.

AU - Osayi, Sylvester N.

AU - Mikami, Dean J.

AU - Needleman, Bradley J.

AU - Melvin, W. Scott

AU - Perry, Kyle A.

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N2 - Background The ideal surgical approach for treatment of symptomatic paraesophageal hernias (PEH) in obese patients remains elusive. The objective of this study was to assess the safety, feasibility, and effectiveness of combined laparoscopic PEH repair and Roux-en-Y gastric bypass (RYGB) for the management of symptomatic PEH in morbidly obese patients.Methods Fourteen patients with symptomatic PEH and morbid obesity (body mass index [BMI]>35 kg/m2) underwent laparoscopic PEH repair with RYGB between 2008 and 2011. Demographic characteristics and preoperative and perioperative details were analyzed. Patients were contacted in October 2013 for follow-up. BMI, reflux symptoms, and disease-specific quality of life (QoL) data were obtained.Results There were 11 females (79%). Median age and preoperative BMI were 48 years and 42 kg/m2, respectively. Mean operative time was 180 minutes, with median length-of-stay of 4 days. There were no perioperative deaths, and 5 patients experienced postoperative complications including 1 gastrojejunostomy leak. Complete follow-up with a median follow-up interval of 35 months was available in 9 (64%) patients. The median % excess weight loss was 67.9%. Thirty-three percent required antisecretory medications for reflux control, compared to 89% preoperatively. Seventy-eight percent of patients reported good to excellent QoL outcomes assessed by the Gastroesophageal Reflux Disease Health-Related Quality of Life questionnaire. Overall, 89% of patients were satisfied with their operation and would undergo the procedure again.Conclusion Combined laparoscopic PEH repair and RYGB is a safe, feasible, and effective treatment option for morbidly obese patients with symptomatic PEH, and offers good to excellent disease-specific quality-of-life outcomes at medium-term follow-up. To date, this is the largest series with the longest follow-up in this unique patient population.

AB - Background The ideal surgical approach for treatment of symptomatic paraesophageal hernias (PEH) in obese patients remains elusive. The objective of this study was to assess the safety, feasibility, and effectiveness of combined laparoscopic PEH repair and Roux-en-Y gastric bypass (RYGB) for the management of symptomatic PEH in morbidly obese patients.Methods Fourteen patients with symptomatic PEH and morbid obesity (body mass index [BMI]>35 kg/m2) underwent laparoscopic PEH repair with RYGB between 2008 and 2011. Demographic characteristics and preoperative and perioperative details were analyzed. Patients were contacted in October 2013 for follow-up. BMI, reflux symptoms, and disease-specific quality of life (QoL) data were obtained.Results There were 11 females (79%). Median age and preoperative BMI were 48 years and 42 kg/m2, respectively. Mean operative time was 180 minutes, with median length-of-stay of 4 days. There were no perioperative deaths, and 5 patients experienced postoperative complications including 1 gastrojejunostomy leak. Complete follow-up with a median follow-up interval of 35 months was available in 9 (64%) patients. The median % excess weight loss was 67.9%. Thirty-three percent required antisecretory medications for reflux control, compared to 89% preoperatively. Seventy-eight percent of patients reported good to excellent QoL outcomes assessed by the Gastroesophageal Reflux Disease Health-Related Quality of Life questionnaire. Overall, 89% of patients were satisfied with their operation and would undergo the procedure again.Conclusion Combined laparoscopic PEH repair and RYGB is a safe, feasible, and effective treatment option for morbidly obese patients with symptomatic PEH, and offers good to excellent disease-specific quality-of-life outcomes at medium-term follow-up. To date, this is the largest series with the longest follow-up in this unique patient population.

KW - Laparoscopy

KW - Morbid obesity

KW - Paraesophageal hernia

KW - Roux-en-Y gastric bypass

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