ArticleSurgical endoscopy2023
Repairing small type I hiatal hernias at the time of RYGB is not necessary to achieve resolution of reflux symptoms.
Article in Surgical endoscopy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed, 6 citations in OpenAlex.
- Multifactorial late complications 13 years after conversion to Roux-en-Y gastric bypass: a case report.Journal of surgical case reports · 2026Article
- Unforeseen pathological and anatomical findings during primary metabolic and bariatric surgery - a retrospective cohort study and review of the literature.BMC surgery · 2025Article
- Outcomes of Concomitant Laparoscopic Sleeve Gastrectomy and Hiatal Hernia Repair on Gastroesophageal Reflux Disease in Patients with Severe Obesity: A Propensity Score-Matched Analysis.Obesity surgery · 2025Article
- GERD after Roux-en-Y Gastric Bypass: Prevalence and Risk Factors Analysis.Medicina (Kaunas, Lithuania) · 2024Article
- Surgeon experience with insurance barriers to offering gastric bypass as an evidence-based operation for pathologic GERD.Surgical endoscopy · 2023Article
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Authors and funding
8 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionRoux-en-Y gastric bypass (RYGB) is the gold standard operation for gastroesophageal reflux disease (GERD) in patients with severe obesity, but there is variability in surgeon opinion regarding whether small type I hiatal hernias (HH) require routine repair concurrently with RYGB. We sought to examine whether leaving small type I HHs unrepaired during RYGB affected GERD outcomes.
methodsPre-operatively our patients all receive endoscopy, and select patients with reflux symptoms receive esophagram based on attending surgeon practice and preference. We routinely repair paraesophageal hernias (PEH) concurrently with RYGB, but refrain from repairing small type I HH if, intra-operatively, the gastric fat pad and cardia are below the diaphragm with no evidence of retraction into the mediastinum. Records from 268 consecutive patients undergoing primary RYGB between January 2016 and February 2021 who completed pre-operative GERD-HRQL assessments were reviewed for presence of type I HH or PEH. Mann-Whitney U tests examined the pre-operative to post-operative change in GERD-HRQL in patients with type I HH left unrepaired at the time of RYGB (HH group) and patients with no hernia (NH group).
resultsPre-operatively, GERD-HRQL scores were not statistically different between HH group (median = 7, mean = 8.5, n = 100) and NH group (median = 6.5, mean = 7.2, n = 141) (p > 0.05). Post-operatively, there was no increase in GERD-HRQL scores patients whose hernias were left unrepaired. Neither group had clinically pathologic post-operative GERD-HRQL scores, with median 6 months scores of 1 for HH group (n = 68) versus 1.5 for NH group (n = 90) (p > 0.05), and median 12 months scores of 1.5 for HH group (n = 40) versus 1 for NH group (n = 56) (p > 0.05).
conclusionRepair of small type I HH is not necessary to achieve effective, durable resolution of reflux symptoms with RYGB. Omitting repair reduces operative time, cost, and potential risk without adverse impact on post-operative reflux symptoms.
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