Laparoscopic Crural Repair With Simultaneous Sleeve Gastrectomy: A Way in Gastroesophageal Reflux Disease Treatment Associated With Morbid Obesity


Ayman M. Soliman 3 , * , Hesham Maged 1 , Ahmed M. Awad 1 , Osama El-Shiekh 1

3 Department of General Surgery, Al Mouwasat Hospital,, Saudi Arabia

1 Department of General Surgery, Ain Shams University Hospital, Cairo, Egypt, 2) Department of General Surgery, Dr. Suliman Fakeeh Hospital, Jeddah, Saudi Arabia, 3) Department of General Surgery, Al Mouwasat Hospital, Saudi Arabia

How to Cite: Soliman A, Maged H, Awad A, El-Shiekh O. Laparoscopic Crural Repair With Simultaneous Sleeve Gastrectomy: A Way in Gastroesophageal Reflux Disease Treatment Associated With Morbid Obesity, J Minim Invasive Surg Sci. Online ahead of Print ; 1(2):67-73. doi: 10.5812/jmiss.5171.


Journal of Minimally Invasive Surgical Sciences: 1 (2); 67-73
Published Online: September 30, 2012
Article Type: Test Research
Received: April 11, 2012
Accepted: May 7, 2012




Background: Laparoscopic sleeve gastrectomy (LSG) has become popular both as a definitive and a staged procedure for morbid obesity. Gastroesophageal reflux disease (GERD) is a common co-morbid disease in bariatric patients.\r\n

Objectives: The aim of this study was to evaluate the efficacy of LSG and hiatal hernia repair (HHR) to treat obesity, complicated by hiatus hernia (HH).

Patients and Methods: The participants in the study were twenty patients, 14 women and 6 men, with a mean body mass index of 43.4 1.9 kg/m2 and mean age of 47 years. All the subjects were eligible for LSG and eight were found to have esophagitis at pre-operative endoscopy. Patients with Barretts esophagus were excluded. GERD symptom questionnaire, 24-hour esophageal pH-metry, and manometry were employed as Pre-and post-procedure assessments. The mean follow-up period was eight months. Clinical outcomes were also evaluated in terms of GERD symptoms improvement or resolution, interruption of antireflux medication, and X-ray evidence of HH recurrence.

Results: Symptomatic HH was diagnosed preoperatively in 18 patients. In the other two patients, HH was asymptomatic and was diagnosed intra-operatively. Prosthetic reinforcement of crural closure was performed in two symptomatic cases with an HH > 5 cm. Mortality was nil and no complications occurred. After a mean follow-up of seven months, GERD symptoms resolution occurred in nine patients, while the other patients reported an improvement of reflux. Body mass index had fallen from 43.4 to 36.2 kg/m2.

Conclusions: A laparoscopic hiatal repair with or without commercially available onlay reinforcement biologic mesh and a sleeve gastrectomy performed at the same time, was successful in controlling the reflux symptoms and reducing body weight.


Laparoscopy Hernia, Hiatal Gastrectomy

© 2012, Journal of Minimally Invasive Surgical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

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