Concurrent Hiatal Hernia Repair and Bariatric Surgery: Outcomes after Sleeve Gastrectomy and Roux-en-Y Gastric Bypass

Abstract Background Hiatal hernias are often repaired concurrently with bariatric surgery to reduce risk of GERD-related complications. Setting 2010-17 US commercial insurance claims dataset. Objectives To examine the association between concurrent hiatal hernia repair (HHR) and bariatric outcomes. Methods We conducted a retrospective cohort study. We identified adults who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) alone, or had bariatric surgery concurrently with HHR. We matched patients with and without HHR, and followed patients up to 3 years for incident abdominal operative interventions, bariatric revisions/conversions, and endoscopy. Time to first event for each outcome was compared using multivariable Cox proportional hazards modeling. Results We matched 1,546 SG patients with HHR to 3,170 SG without HHR; and 457 RYGB patients with HHR to 1,156 RYGB patients without HHR. Seventy-three percent had a full year of post-operative enrollment. Patients who underwent concurrent SG and HHR were more likely to have additional abdominal operations (aHR (95% CI) 2.1 (1.5, 3.1)) and endoscopies (aHR 1.5 (1.2, 1.8)), but not bariatric revisions/conversions (aHR 1.7 (0.6, 4.6)) by 1 year after surgery, a pattern maintained at 3 years of follow-up. Among RYGB patients, concurrent HHR was associated only with an increased risk of endoscopy (aHR 1.4 (1.1, 1.8)) at one year of follow-up, persisting at three years. Conclusions Concurrent SG/HHR was associated with increased risk of some subsequent operative and non-operative interventions, a pattern that was not consistently observed for RYGB. Additional studies could examine whether changes to concurrent HHR technique could reduce risk.