Impact of crural repair with gastroesophageal junction stitching to left crus during sleeve gastrectomy in morbidly obese patients with hiatus hernia

Background
The actual effect of laparoscopic sleeve gastrectomy (LSG) on patients having gastroesophageal reflux disease (GERD) symptoms is still controversial. Repair of accidently discovered hiatus hernia during LSG is commonly advocated by many authors; however, data are not enough on the outcomes of GERD symptoms in these patients. The aim of this study is to evaluate the effect of restoration of gastroesophageal junction complex as protective mechanism through concomitant hiatal hernia repair, proper dissection of 2–3 cm of intraabdominal esophagus, and stitching of gastroesophageal junction to left crus of diaphragm on GERD symptoms in morbidly obese patients undergoing LSG.
Patients and methods
This is an observational study including 40 patients who previously have had LSG with crural repair and stitching of gastroesophageal junction to left crus of diaphragm in the same operation. Patients were treated at Ain Shams University hospitals from January 2017 to January 2019.
Results
The mean age of the study population was 37±11 years (range, 20–55 years). The mean BMI of the morbidly obese patients was 43.95±2.58 (40–49). Symptoms of GERD were presented only in 28 (70%) patients collected by GERD-Health Related Quality of Life questionnaire, and hiatal hernia was diagnosed in them by preoperative upper endoscopy. The mean follow-up was 6 months during which remission of GERD symptoms occurred in 36 (90%) patients along with regression of esophagitis as diagnosed by upper endoscopy 6 months postoperatively.
Conclusion
Sleeve gastrectomy with concomitant crural repair and stitching of gastroesophageal junction to left crus of diaphragm is considered a feasible and safe technique providing good results in management of GERD symptoms for obese patients with reflux symptoms and hiatus hernia.