Prevalence of hiatal hernia in the morbidly obese.

BACKGROUND: Morbidly obese patients commonly have gastroesophageal reflux (GERD) and associated hiatal hernias. As such, some surgeons routinely perform a concomitant hiatal hernia repair during bariatric surgery. However, the intraoperative inspection for a hiatal hernia based on laparoscopic visualization can be misleading. The aim of this study was to assess the prevalence of hiatal hernias in morbidly obese patients based on preoperative upper gastrointestinal (GI) contrast study. METHODS: Data on 181 patients who underwent routine upper GI contrast study as part of a preoperative workup for bariatric surgery were reviewed. The upper GI studies were examined for the presence of hiatal hernias and GERD. Hiatal hernias were categorized by size as small (≤2 cm), moderate (2-5 cm), or large (>5 cm). GERD was based on radiologic evidence and categorized as mild, moderate, or severe. RESULTS: The mean age of the cohort was 44 years, with a mean body mass index of 43 kg/m(2). Of the 181 patients overall, based on the upper GI contrast study, the prevalence of hiatal hernia was 37.0% and of GERD was 39.8%; the prevalence of moderate or large hiatal hernia was 4.4%, and the prevalence of moderate or severe GERD was 13.3%. CONCLUSIONS: Based on upper GI contrast study, we identified the presence of a hiatal hernia in nearly 40% of morbidly obese patients. The results from this study suggest that surgeons should evaluate the morbidly obese patient for the presence of hiatal hernias and perform concomitant repair at the time of the bariatric procedure, particularly in patients undergoing gastric banding and sleeve gastrectomy, while less so in the gastric bypass patient.

Resolution of systemic hypertension after laparoscopic gastric bypass.

BACKGROUND: Hypertension is a well-recognized and treatable risk factor for coronary heart disease and is one of the most common comorbidities associated with obesity. The aim of this study was to characterize the clinical outcome of a cohort of patients with documented hypertension who underwent laparoscopic gastric bypass. METHODS: Ninety-five obese patients with documented hypertension and being treated with antihypertensive medication(s) underwent laparoscopic gastric bypass. Main outcome measures included length of hypertensive condition, changes in systolic and diastolic blood pressures, and changes in antihypertensive medication(s) at follow-up. RESULTS: There were 69 (72%) females with a mean preoperative body mass index of 47 kg/m(2). The mean duration of hypertension was 73 +/- 70 months. The mean excess body weight loss at 12 months was 66%. The mean systolic blood pressure significantly decreased from 140 +/- 17 mmHg preoperatively to 120 +/- 18 mmHg at 12 months (p < 0.01). The mean diastolic blood pressure also significantly decreased from 80 +/- 11 mmHg preoperatively to 71 +/- 8 mmHg at 12 months (p < 0.01). At 12 months follow-up, 44 (46%) patients had complete resolution of hypertension while 18 (19%) patients had improvement. Patients with complete resolution had a shorter duration of disease as compared to patients without resolution (53 vs. 95 months, respectively, p = 0.01). CONCLUSION: Weight loss associated with laparoscopic gastric bypass substantially improves and/or resolves hypertension in the majority of patients. Improvement of hypertension occurs as early as 1 month postoperatively and is more frequently in patients with a shorter preoperative duration of disease.