Laparoscopic Hiatus Hernia Repair with BIO-A® mesh is Safe and Effective for Patients Suffering Severe Gastro-Esophageal Reflux Disease After Sleeve Gastrectomy – A Single Surgeon Experience

Introduction: There is a complex relationship between gastroesophageal reflux disease (GORD), hiatus hernia, obesity, and metabolic bariatric surgery. We report the outcomes of laparoscopichiatus hernia repair (HHR) with BIO-A® mesh in the management of GORD post LSG in patients who developed a hiatus hernia with migration of the proximal gastric sleeve. Methods: A retrospective review of 50 patients who previously underwent LSG andrevisional surgery (HHR, n=25; RYGB, n=25) between 2011 and 2022. The modifiedDeMeester scoring system was used to assess the severity of the patient’s GORD symptoms pre-HHR/pre-RYGB and 6 months post-op. Results: Twenty-fivepatients underwent HHR with BIO-A® mesh following a previous LSG. The severity of GORD six months post-HHR was significantly lower(0.96 ± 0.84 vs. 2.60 ± 0.50, p= <0.0001). After HHR, 3/25 (12%) patients had ongoing GORD symptoms that were not medically controlled and underwent conversion to RYGB. In contrast, 25 patients underwent direct conversion to RYGB following a previous LSG. The severity of GORD at6 months post-RYBG was significantly lower (0.40 ± 0.50 vs. 2.36 ± 0.64, p= <0.0001). At six months, there was no significant difference in GORD symptoms when HHR was compared with RYGB (3.32 ± 1.6 vs 3.76 ± 1.54, p=0.4296). Conclusion: In appropriately selected patients, HHR with BIO-A® meshappears safe and effective in managing persistent GORDfollowing LSG, with the added benefit of having a lower risk for serious complications and long-term sequelae associated with RYGB.