P0867 - Laparoscopic Hiatal Hernia Repair Outcomes in Obese Patients

M'hamed Turki, MD¹, Saif Bella, MD², Patrick Castle, ³, Alexsaundra Zywicki, ⁴, Amine Hila, MD^2
1United Health Services, Johnson City, NY; ²United Health Services, Binghamton, NY; ³State University of New York Upstate Medical Center, Johnson City, NY; ⁴SUNY Upstate Medical University, Johnson City, NY

Introduction: Obesity is a significant risk factor for gastroesophageal reflux disease (GERD) and hiatal hernia (HH). Anti-reflux surgery and HH repair are both indicated for the management of refractory GERD. Data regarding HH repair and anti-reflux surgery outcomes in obese patients are limited. The goal of the study is to compare the outcomes of HH repair and anti-reflux surgery based on patients’ BMI.

Methods: We retrospectively reviewed consecutive elective laparoscopic HH repair and Nissen fundoplication procedures, from January 2010 to February 2020, performed with the primary indication of HH with refractory GERD. The subjects were divided into 2 groups, BMI< 30 and BMI >=30. The primary efficacy outcome measures were a relief from GERD symptoms, as reported in the follow-up visit and discontinuation of anti-reflux medications. Secondary outcome measures were the procedure's overall outcome, including ICU admission, ≥2 g/dl drop in Hgb postoperatively, more than 48 hours length of stay, hospital readmission, and transient postoperative dysphagia.

Results: Preliminary data of 212 patients were collected and analyzed. One hundred twelve were obese. Mean age was 60 years old. There was no statistical difference with primary outcomes. In terms of secondary outcomes, morethan 48 hours length of stay, drop-in Hgb, and transient dysphagia were significantly more common in patients with BMI >30. (Table 1, Chart1)

Discussion: Our preliminary analysis suggested that combined laparoscopic HH repair with Nissen fundoplication offers an effective modality of treatment in obese patients with HH and refractory GERD. However, our study is showing that these surgeries were associated with higher short-term morbidity in this group.
Hence, risk stratification and approach modification should be considered in the surgical treatment indications.




Disclosures:


M'hamed Turki, MD¹, Saif Bella, MD², Patrick Castle, ³, Alexsaundra Zywicki, ⁴, Amine Hila, MD². P0867 - Laparoscopic Hiatal Hernia Repair Outcomes in Obese Patients, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.