Prospective Long-Term Outcomes in Patients Undergoing Laparoscopic Sleeve Gastrectomy With and Without Hiatal Hernia Repair
Edgardo J. Monzon Canales, Alejandro J. Ribieras, Nestor de la Cruz-Muñoz
- This study examined whether repairing a hiatal hernia during sleeve gastrectomy leads to better long-term outcomes, including less reflux.
- Many patients don't know they have a hiatal hernia until it's found during surgery.
- Dr. de la Cruz-Muñoz has studied this question for years, including a related 2023 peer-reviewed study.
- Presented at the 2024 ASMBS Annual Meeting, the largest bariatric surgery conference in the US.
- This shows a proactive, evidence-based approach to managing hiatal hernias during primary surgery.
This prospective study evaluated long-term outcomes in patients undergoing laparoscopic sleeve gastrectomy with and without concomitant hiatal hernia repair, comparing weight loss, GERD symptom resolution, and complication rates over extended follow-up. Findings contribute to the clinical debate on routinely addressing hiatal hernias at the time of primary sleeve gastrectomy. Presented at the 40th Annual ASMBS Meeting in San Diego, California.
Why This Research Was Needed
Reflux is the main long-term concern with sleeve gastrectomy, and a hiatal hernia is one of its key causes. Whether routinely finding and repairing hernias during a sleeve improves long-term results has been debated for more than a decade, including in Dr. de la Cruz-Muñoz’s 2014 SOARD commentary.
What Was Presented
This abstract, presented at the 2024 Annual Meeting of the American Society for Metabolic and Bariatric Surgery and published in Surgery for Obesity and Related Diseases, reported prospective long-term outcomes in patients who had a sleeve gastrectomy with or without hiatal hernia repair, including weight loss, reflux symptoms and complications. It continues the prospective research program in which our 2023 SOARD study showed that preoperative tests miss most hiatal hernias and that careful inspection during surgery finds many more.
What This Means for Patients
If you are planning a sleeve, ask how your surgeon evaluates and repairs the hiatus. If you have reflux after sleeve gastrectomy, an untreated or recurrent hernia may be the cause; hiatal hernia repair after sleeve or sleeve-to-bypass conversion can help. See our Reflux Surgery Guide.
Strengths and Limitations
Prospective follow-up within a randomized trial is a strong design. A meeting abstract is a brief report, and full peer-reviewed results will provide the details.
Expert Commentary
This is the question I have been working on for over a decade: should we look for and repair every hiatal hernia during a sleeve? Following these patients prospectively over the long term is how we get a real answer, rather than relying on opinion.
— Dr. Nestor de la Cruz-Muñoz
Related Research
Monzon Canales EJ, Ribieras AJ, De La Cruz-Muñoz N. A405 Prospective Long-Term Outcomes in Patients Undergoing Laparoscopic Sleeve Gastrectomy With and Without Hiatal Hernia Repair. 40th Annual Meeting of the American Society for Metabolic and Bariatric Surgery, San Diego, California. Surg Obes Relat Dis. 2024;20(6):S117.
