Laparoscopic roux-en-y gastric bypass for the management of hiatal hernia and failed fundoplication in patients with obesity

Abstract

Gastroesophageal reflux disease (GERD) and hiatal hernias (HH) are more common in patients with obesity. Laparoscopic HH repair with fundoplication is a safe and effective procedure in the non-obese patient. The efficacy and durability of this procedure in the population with morbid obesity is questionable. Bariatric surgery has been shown to improve GERD symptoms and is commonly performed as a standalone procedure to treat small HH. Herein is a review of the surgical management of the HH in the obese population. Based on the available literature, the laparoscopic Roux-en-Y gastric bypass (RYGB) with HH repair should be considered effective for both primary treatment of a HH as well as for the treatment for failed anti-reflux surgery in obese patients.