Routine Hiatal Dissection and Repair Does Not Improve Short-Term Reflux After Vertical Sleeve Gastrectomy

Background: Gastroesophageal reflux disease (GERD) can be exacerbated or incited by VSG, potentially even leading to Barrett's esophagus. There is limited data regarding the impact of selective versus routine hiatal dissection and repair on GERD after VSG. Methods: A retrospective, single-center analysis of patients undergoing primary VSG for morbid obesity between 2015 and 2017. GERD was evaluated by the GERD-HRQL questionnaire. Results: We assessed 290 consecutive patients (median age 43 years; 71% female). Among the 276 (95%) who underwent preoperative endoscopy, 39% were found to have a hiatal hernia. There were 246 (85%) who underwent concurrent hiatal hernia repair. One surgeon performed routine hiatal dissection in 97% of his cases, whereas the other three surgeons in the group performed selective dissection in 66% of their cases. Baseline BMI, rate of preoperative endoscopy, and prevalence of hiatal hernia on endoscopy between the routine and selective groups were statistically similar. The median HRQL score for the routine and selective groups preoperatively, 1 month postop, and 3 months postop were 4 vs 3, 2 vs 3, and 2 vs 2 (p=NS), respectively. At 3 months, 7 (4%) patients within the routine group and 6 (5%) in the selective group had a HRQL score ≥ 15. Conclusions: There is no difference in reflux 3 months after VSG as measured by a validated questionnaire in patients undergoing routine versus selective concurrent hiatal hernia repair. A properly designed randomized controlled trial should be performed to assess the true value of hiatal interrogation during VSG.