Hiatoplasty in combination with lap-band is indicated in obese subjects with hiatal hernia

Background: The aim of this study is to evaluate the influence of Hiatoplasty (H), posterior repair of diaphragmatic crura, combined with Lap-Band System procedure, in morbidly obese with hiatal hernia. Methods: A case-control study was performed involving patients submitted to Lap-Band System procedure + H since December 1996: 161/5,364 (3.0%) patients (24M/137F) (Group A) were compared with 161 patients LapBand-System alone oper- ated during the same period (Group B), matched for sex, age, band positioning technique, and BMI. Operative time, mortality, operative complications, laparotomic conversion, hospital stay,BMI and %EWL were considered. Data were expressed as mean±standard deviation, P<0.05 was considered significant (Fisher exact test). Results: LapBand-System was positioned by perigastric or pars-flaccida technique in 74 and 87 patients of both group (mean age: 47.4±10.7 and 46.9±10.2 years; mean BMI: 39.2±5.4 and 39.9±5.1 in Group A and B respectively). Mortality, laparotomic conversion, intra/postoperative complications, gastric pouch dila- tion and erosion were absent in both groups. Significantly longer operative time (89.2±54.4 vs 77.9±30.2 minutes; P<0.01) and hospital stay (3.1±2.4 vs 2.4±3.3 days; P<0.05) was observed in Group A. At 3 and 5 years mean BMI was 33.2±2.8 and 30.1±4.4 in Group A, and 33.6±7.2 and 30.6±7.3 in Group B (P=ns). Mean %EWL at same intervals was 51.2±12.7 and 55.1±12.7 in Group A, and 51.4±10.7 and 54.4±10.7 in Group B (P=ns). Patients with %EWL<25 at 5 years follow-up were 31/161(19.2%) and 33/161(20.5%) in Group A and B respectively (P=ns). Conclusions: Hiatal hernia repair performed during Lap-Band System does not add mortality, complications or differences in weight loss to Lap-Band System procedures, but only a longer operative time and hospital stay.