Hiatal Hernia Repair in Laparoscopic Adjustable Gastric Banding and Laparoscopic Roux-En-Y Gastric Bypass: A National Database Analysis
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Hiatal hernia (HH) repairs are commonly done concomitantly with laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB) to decrease gastroesophageal reflux disease (GERD). There is limited evidence about the additional surgical risk these combined procedures engender. We used the United States Nationwide Inpatient Sample 2004–2009 to compare mortality risk, prolonged length of stay (PLOS), and perioperative adverse events using propensity score-matched analysis. We repeated the analysis after removing patients diagnosed with GERD. There were 42,272 weighted patients undergoing LRYGB alone representing 206,559 discharges nationally and an additional 1,945 and 9,060, respectively, undergoing LRYGB + HH repair. For LAGB, there were 10,558 records representing 52,901 LAGB-only discharges and 1,959 representing 9,893 LAGB + HH repair discharges. Thirty-eight percent (95 % CI: 36, 41 %) of the patients in the LRYGB-only group had GERD compared to 55 % (51, 59 %) in the LRYGB + HH repair group. Among the LAGB groups, 31 % (28, 34 %) of LAGB-only patients had GERD compared to 44 % (38, 49 %) in the LAGB + HH repair group. We find that the average treatment effect on the treated (considering the concomitant procedure as treatment and the single procedure as control) for PLOS was −0.12353 (−0.15909, −0.08797) between the LRYGB groups and −0.04353 (−0.07488, −0.01217) for the LAGB groups. We find no evidence of increased risk of perioperative adverse events among patients undergoing concomitant HH repair with LRYGB or LAGB. Patients undergoing the combined procedure appear to be at lower risk of PLOS; this may be due to surgical training norms.
KeywordsHiatal hernia repair Laparoscopic adjustable gastric band Laparoscopic Roux-en-Y Gastric bypass
Gastroesophageal reflux disease
Laparoscopic Roux-en-Y gastric bypass
Laparoscopic adjustable gastric banding
Prolonged length of stay
Nationwide Inpatient Sample
Average treatment effect on the treated
International Classification of Diseases version 9
We would like to thank Mr. Mathew Grabau, Ms. Nikki Voulgaropoulos, Mrs. Bridget Slusarek, Mrs. Elsie Waddick, Mrs. Barbara Sampson, Dr. Nathan Liu, and Dr. Aboude Nowaylati for their helpful contributions. B.J.S. al-Haddad and Y. Kim were supported by NIH MSTP grant T32 GM008244 and the Department of Surgery Research Funds. R.B. Dorman, N.F. Rasmus, S. Ikramuddin, and D.B. Leslie were supported by the Department of Surgery Research Funds.
Conflict of interest
B.J.S. al-Haddad has no conflict of interest. R.B. Dorman has no conflict of interest. N.F. Rasmus has no conflict of interest. Y. Kim has no conflict of interest. S. Ikramuddin has no conflict of interest. D.B. Leslie has no conflict of interest.
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