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

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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.

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References

  1. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO Worldwide Survey 2014. Obes Surg. 2017;27(9):2279–89.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Gagner M, Hutchinson C, Rosenthal R. Fifth International Consensus Conference: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2016;12(4):750–6.

    Article  PubMed  Google Scholar 

  3. Stenard F, Iannelli A. Laparoscopic sleeve gastrectomy and gastroesophageal reflux. World J Gastroenterol. 2015;21(36):10348–57.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Yeung KTD, Penney N, Ashrafian L, et al. Does sleeve gastrectomy expose the distal esophagus to severe reflux?: A systematic review and meta-analysis. Ann Surg. 2020;271(2):257–65.

    Article  PubMed  Google Scholar 

  5. Bevilacqua LA, Obeid NR, Yang J, et al. Incidence of GERD, esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma after bariatric surgery. Surg Obes Relat Dis. 2020;16(11):1828–36.

    Article  PubMed  Google Scholar 

  6. Braghetto I, Csendes A. Prevalence of Barrett’s esophagus in bariatric patients undergoing sleeve gastrectomy. Obes Surg. 2016;26(4):710–4.

    Article  PubMed  Google Scholar 

  7. Qumseya BJ, Qumsiyeh Y, Ponniah SA, et al. Barrett’s esophagus after sleeve gastrectomy: a systematic review and meta-analysis. Gastrointest Endosc. 2021;93(2):343–52.e2.

    Article  PubMed  Google Scholar 

  8. Genco A, Castagneto-Gissey L, Lorenzo M, et al. Esophageal adenocarcinoma after sleeve gastrectomy: actual or potential threat? Italian series and literature review. Surg Obes Relat Dis. 2021;17(5):848–54.

    Article  PubMed  Google Scholar 

  9. Coleman HG, Xie SH, Lagergren J. The epidemiology of esophageal adenocarcinoma. Gastroenterology. 2018;154(2):390–405.

    Article  PubMed  Google Scholar 

  10. Wilson LJ, Ma W, Hirschowitz BI. Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol. 1999;94(10):2840–4.

    Article  CAS  PubMed  Google Scholar 

  11. Che F, Nguyen B, Cohen A, et al. Prevalence of hiatal hernia in the morbidly obese. Surg Obes Relat Dis. 2013;9(6):920–4.

    Article  PubMed  Google Scholar 

  12. Carabotti M, Avallone M, Cereatti F, et al. Usefulness of upper gastrointestinal symptoms as a driver to prescribe gastroscopy in obese patients candidate to bariatric surgery. A Prospective Study. Obes Surg. 2016;26(5):1075–80.

    Article  PubMed  Google Scholar 

  13. Ouyang W, Dass C, Zhao H, et al. Multiplanar MDCT measurement of esophageal hiatus surface area: association with hiatal hernia and GERD. Surg Endosc. 2016;30(6):2465–72.

    Article  PubMed  Google Scholar 

  14. Koch OO, Schurich M, Antoniou SA, et al. Predictability of hiatal hernia/defect size: is there a correlation between pre- and intraoperative findings? Hernia. 2014;18(6):883–8.

    Article  CAS  PubMed  Google Scholar 

  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. 2013;9(3):361–2.

    Article  PubMed  Google Scholar 

  16. Arnoldner MA, Felsenreich DM, Langer FB, et al. 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):1902–8.

    Article  PubMed  Google Scholar 

  17. Soricelli E, Iossa A, Casella G, et al. Sleeve gastrectomy and crural repair in obese patients with gastroesophageal reflux disease and/or hiatal hernia. Surg Obes Relat Dis. 2013;9(3):356–62.

    Article  PubMed  Google Scholar 

  18. Rosenthal RJ, Diaz AA, Arvidsson D, et al. 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.

    Article  PubMed  Google Scholar 

  19. Dakour Aridi HN, Tamim H, Mailhac A, et al. Concomitant hiatal hernia repair with laparoscopic sleeve gastrectomy is safe: analysis of the ACS-NSQIP database. Surg Obes Relat Dis. 2017;13(3):379–84.

    Article  PubMed  Google Scholar 

  20. Janik MR, Ibikunle C, Aryaie AH. 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):365–71.

    Article  PubMed  Google Scholar 

  21. Aridi HD, Asali M, Fouani T, et al. Gastroesophageal reflux disease after laparoscopic sleeve gastrectomy with concomitant hiatal hernia repair: an unresolved question. Obes Surg. 2017;27(11):2898–904.

    Article  Google Scholar 

  22. Mahawar KK, Carr WR, Jennings N, et al. Simultaneous sleeve gastrectomy and hiatus hernia repair: a systematic review. Obes Surg. 2015;25(1):159–66.

    Article  PubMed  Google Scholar 

  23. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. Jama. 2000;283(15):2008–12.

    Article  CAS  PubMed  Google Scholar 

  25. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.

    Article  PubMed  Google Scholar 

  26. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12.

    Article  CAS  PubMed  Google Scholar 

  27. Freeman MF, Tukey JWJTAoMS. Transformations related to the angular and the square root. 1950; 607-11.

  28. Snyder B, Wilson E, Wilson T, et al. A randomized trial comparing reflux symptoms in sleeve gastrectomy patients with or without hiatal hernia repair. Surg Obes Relat Dis. 2016;12(9):1681–8.

    Article  PubMed  Google Scholar 

  29. Daes J, Jimenez ME, Said N, et al. Laparoscopic sleeve gastrectomy: symptoms of gastroesophageal reflux can be reduced by changes in surgical technique. Obes Surg. 2012;22(12):1874–9.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Samakar K, McKenzie TJ, Tavakkoli A, et al. The effect of laparoscopic sleeve gastrectomy with concomitant hiatal hernia repair on gastroesophageal reflux disease in the morbidly obese Obes Surg 2016; 26(1): 67. (vol 26, pg 61, 2016).

  31. Attia SGJEp. Laparoscopic sleeve gastrectomy and crural repair as a treatment of morbid obesity associated with gastroesophageal reflux. 2017; 9(1): 3529.

  32. Elmaleh HM, Elnabeel Mortada A, Khaled RA. Evaluation of anterior phrenoesophageal ligament preservation during hiatus hernia repair in laparoscopic sleeve gastrectomy as an anti-reflux measure. Journal of laparoendoscopic & advanced surgical techniques Part A, 2021;

  33. Boru CE, Coluzzi MG, de Angelis F, et al. Long-term results after laparoscopic sleeve gastrectomy with concomitant posterior cruroplasty: 5-year follow-up. J Gastrointest Surg. 2020;24(9):1962–8.

    Article  PubMed  Google Scholar 

  34. Soliman AM, Maged H, Awad AM, El-Shiekh OJOS. Laparoscopic crural repair with simultaneous sleeve gastrectomy: a way in gastroesophageal reflux disease treatment associated with morbid obesity 2012; 1(2): 71-7.

  35. Santonicola A, Angrisani L, Cutolo P, et al. The effect of laparoscopic sleeve gastrectomy with or without hiatal hernia repair on gastroesophageal reflux disease in obese patients. Surg Obes Relat Dis. 2014;10(2):250–5.

    Article  PubMed  Google Scholar 

  36. El Chaar M, Ezeji G, Claros L, et al. Short-term results of laparoscopic sleeve gastrectomy in combination with hiatal hernia repair: experience in a single accredited center [J]. Obes Surg. 2016;26(1):68–76.

    Article  PubMed  Google Scholar 

  37. Elwan AM, Abomera MA, Ibrahim AR, et al. Feasibility of laparoscopic management of hiatal hernia and/or gastroesophageal reflux disease with laparoscopic sleeve gastrectomy or greater curvature plication in morbidly obese patients. Trends in Medical Research. 2016;11(2):54–61.

    Article  Google Scholar 

  38. Balla A, Quaresima S, Ursi P, et al. Hiatoplasty with crura buttressing versus hiatoplasty alone during laparoscopic sleeve gastrectomy. Gastroenterology Research and Practice, 2017; 2017

  39. Garg H, Vigneshwaran B, Aggarwal S, et al. Impact of concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair on gastro-oesophageal reflux disease in morbidly obese patients. Journal of Minimal Access Surgery. 2017;13(2):103–8.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Gero D, Ribeiro-Parenti L, Arapis K, et al. Sleeve gastrectomy combined with the simplified hill repair in the treatment of morbid obesity and gastro-esophageal reflux disease: preliminary results in 14 patients. World J Surg. 2017;41(4):1035–9.

    Article  PubMed  Google Scholar 

  41. Angrisani L, Santonicola A, Borrelli V, et al. Sleeve gastrectomy with concomitant hiatal hernia repair in obese patients: long-term results on gastroesophageal reflux disease. Surg Obes Relat Dis. 2020;16(9):1171–7.

    Article  PubMed  Google Scholar 

  42. Lye TJY, Ng KR, Tan AWE, et al. Small hiatal hernia and postprandial reflux after vertical sleeve gastrectomy: a multiethnic Asian cohort. Plos One, 2020; 15(11):

  43. Shafik YS, ElBarbary MG, Lasheen M. Impact of crural repair with gastroesophageal junction stitching to left crus during sleeve gastrectomy in morbidly obese patients with hiatus hernia. Egyptian Journal of Surgery. 2020;39(4):1111–7.

    Google Scholar 

  44. Sharma A, Aggarwal S, Ahuja V, et al. Evaluation of gastroesophageal reflux before and after sleeve gastrectomy using symptom scoring, scintigraphy, and endoscopy. Surg Obes Relat Dis. 2014;10(4):600–5.

    Article  PubMed  Google Scholar 

  45. Rebecchi F, Allaix ME, Giaccone C, et al. Gastroesophageal reflux disease and laparoscopic sleeve gastrectomy: a physiopathologic evaluation. Ann Surg. 2014;260(5):909–14. discussion 14-5

    Article  PubMed  Google Scholar 

  46. Termine P, Boru CE, Iossa A, Ciccioriccio MC, Campanelli M, Bianciardi E, Gentileschi P, Silecchia G Transhiatal migration after laparoscopic sleeve gastrectomy: myth or reality? A multicenter, retrospective study on the incidence and clinical impact. Obes Surg, 2021;

  47. DuPree CE, Blair K, Steele SR, et al. Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease: a national analysis. JAMA Surg. 2014;149(4):328–34.

    Article  PubMed  Google Scholar 

  48. Peterli R, Wölnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. Jama. 2018;319(3):255–65.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Borbély Y, Kröll D, Nett PC, et al. Radiologic, endoscopic, and functional patterns in patients with symptomatic gastroesophageal reflux disease after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2018;14(6):764–8.

    Article  PubMed  Google Scholar 

  50. Oor JE, Roks DJ, Ünlü Ç, et al. Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Surg. 2016;211(1):250–67.

    Article  PubMed  Google Scholar 

  51. Memon MA, Memon B, Yunus RM, et al. Suture cruroplasty versus prosthetic hiatal herniorrhaphy for large hiatal hernia: a meta-analysis and systematic review of randomized controlled trials. Ann Surg. 2016;263(2):258–66.

    Article  PubMed  Google Scholar 

  52. Felsenreich DM, Kefurt R, Schermann M, et al. Reflux, sleeve dilation, and Barrett’s esophagus after laparoscopic sleeve gastrectomy: long-term follow-up. Obes Surg. 2017;27(12):3092–101.

    Article  PubMed  Google Scholar 

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Author notes

  1. Wenhui Chen and Jia Feng contributed equally to this work.

Authors and Affiliations

  1. Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, China

    Wenhui Chen, Cunchuan Wang, Yucheng Wang, Wah Yang & Zhiyong Dong

  2. Department of Cellular Biology, Institute of Biomedicine, Jinan University, Guangzhou, China

    Jia Feng

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  1. Wenhui Chen
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Key Points

• Concomitant SG and HHR can be a positive effect on weight loss, GERD resolution, esophagitis reduction, and GERD-HRQL improvement.

• Concomitant SG and HHR are superior to SG alone in GERD remission, but there was no significant difference in the de novo GERD.

• Concomitant SG and HHR seem to have a promising future in patients with obesity and GERD.

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Chen, W., Feng, J., Wang, C. et al. Effect of Concomitant Laparoscopic Sleeve Gastrectomy and Hiatal Hernia Repair on Gastroesophageal Reflux Disease in Patients with Obesity: a Systematic Review and Meta-analysis. OBES SURG 31, 3905–3918 (2021). https://doi.org/10.1007/s11695-021-05545-0

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  • DOI: https://doi.org/10.1007/s11695-021-05545-0

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