Background

Hiatal hernia (HH) with pouch migration after Roux-en-Y Gastric Bypass (RYGB) is a rare, yet serious complication that requires surgery. The aim of this study was to evaluate the resolution of symptoms in patients with HH repair after prior RYGB.

Methods

A retrospective study was conducted from 2010 to 2022. Patients with HH repair alone after prior RYGB were included. Patients undergoing concurrent revisional bariatric procedures were excluded. Baseline characteristics and surgical outcomes were evaluated.

Results

Forty-four patients were included. Median time from index RYGB to HH repair was 5 years. The median BMI at HH repair was 30 kg/m2. From reports available, four patients had concomitant HH repairs at initial operation. The most common presenting symptoms of hernia were dysphagia (48%), gastric reflux (39%), and abdominal pain (36%). The median size of HH was 4 cm. 98% of HH repairs were completed laparoscopically and 2% robotically. Nonabsorbable suture was used in 98% of patients, with bioabsorbable mesh in 30%. The median follow-up time was 28 days (range 12-117). 70% of patients reported full resolution of symptoms, 23% partial resolution, and 7% no resolution. At follow up, 2% had evidence of radiologic recurrence and 2% symptomatic recurrence.

Conclusions

This is the largest series of hiatal hernia repair alone after previous RYGB. HH with pouch migration after RYGB commonly manifests with dysphagia and reflux. Surgical repair yields a high rate of symptom resolution in the short term. Longer follow-up is needed to evaluate durability of this intervention.