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Augmentation of Hiatal Repair with the Ligamentum Teres Hepatis for Intrathoracic Gastric Migration After Bariatric Surgery

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Abstract

Purpose

The augmentation of hiatoplasty (HP) with the ligamentum teres hepatis (LTA) is a new concept for intrathoracic migration of a gastric sleeve or pouch (ITGM). We retrospectively analyzed all cases of hiatal hernia repair in a single center between 2015 and 2019.

Methods

A total of 171 patients underwent 307 hiatal hernia repairs after sleeve gastrectomy (SG) (n = 79), Roux-en-Y gastric bypass (RYGB) (n = 129), and one anastomosis gastric bypass (OAGB) (n = 99). Each hiatal hernia repair was defined as a “case” and assigned to the LTA group or the non-LTA group. The primary outcome was the recurrence of ITGM as detected by endoscopy or CT.

Results

The basic characteristics in the LTA group (78 cases) and the non-LTA group (229 cases) were comparable with the exception of the rate of revisional HP (72% vs. 21%), the rate of prior conversion to RYGB (33% vs. 17%), the initial BMI (45.9 ± 8.2 kg/m2 vs. 49.0 ± 8.8 kg/m2), and the follow-up (7 months (1–16) vs. 8 months (1–54)). The ITGM recurrence rate was 15% in the LTA group and 72% in non-LTA group (p < 0.001). Multivariate analysis showed that the length of ITGM and the type of surgical repair were independent risk factors. The addition of LTA to HP lowered the probability of ITGM recurrence by a factor of 0.35 (p = 0.015), but the conversion from SG or OAGB to RYGB did not reduce the risk.

Conclusions

LTA reduces the risk of early ITGM recurrence. The long-term durability, however, needs to be further investigated.

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Abbreviations

HP:

Hiatoplasty

ITGM:

Intrathoracic gastric migration

LTA:

Ligamentum teres augmentation

OAGB:

One anastomosis gastric bypass

RYGB:

Roux-en-Y gastric bypass

SG:

Sleeve gastrectomy

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Authors and Affiliations

  1. Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Alexander Runkel

  2. Department of Obesity and Metabolic Surgery, Sana-Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany

    Oliver Scheffel & Norbert Runkel

  3. Centre for Obesity and Metabolic Surgery, Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Goran Marjanovic

  4. Obesity and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy

    Sonja Chiappetta

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  1. Alexander Runkel
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  2. Oliver Scheffel
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Correspondence to Norbert Runkel.

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Runkel, A., Scheffel, O., Marjanovic, G. et al. Augmentation of Hiatal Repair with the Ligamentum Teres Hepatis for Intrathoracic Gastric Migration After Bariatric Surgery. OBES SURG 31, 1422–1430 (2021). https://doi.org/10.1007/s11695-020-05153-4

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