Hiatal hernia repair or revision to a gastric bypass along with hernia repair?

Question

Experiencing intermittent pain & discomfort while eating 4 yrs post gastric sleeve surgery. Had upper GI. Bariatric surgeon says my stomach is going into my esophagus due to a severe hiatal hernia. He suggests doing a revision to a gastric bypass & fixing the hernia for best results. He says just fixing the hernia may only be a temp fix with risk of reherniating a possibility down the line. I don't want a gastric bypass, but I also don't want to end of doing another surgery a few years from now.

Elias Darido, MD, FACS · Answer

Great question with very little evidence in the literature to give you a clear answer.Converting sleeve to bypass does not necessarily prevent hernia recurrence. You can have a gastric bypass and still herniate into the chest and cause pain and difficulty swallowing In my opinion, the key to your revision surgery is full mobilization of the esophagus and good hiatal hernia repairI think Adding a gastric bypass may prevent acid reflux after hiatal hernia repair. If you suffer from acid reflux now there may be a value in converting to bypasshope this helps

Carson C. Cunningham, MD · Answer

If you have significant acid reflux from your stomach into your esophagus, then conversion to gastric bypass + hiatal hernia repair will be helpful. The key to a good hiatal hernia repair in mobilizing the lower esophagus so that it sits comfortably in the abdomen without tension. Re-inforcing the diaphragm repair with mesh is also be something I would add.

Pablo Garcia, MD - Account Suspended · Answer

Hello, I hope you are well. I am sorry to hear you are struggling with a hiatal hernia after your gastric sleeves. Unfortunately, gastris sleeves increase the risk of developing them. I understand you are hesitant to get surgery again, however what your doctor is recommending is precisely what should be done in your case. It is also worth noting that there is always a risk of reherniation with any hernia repair.

Mark Pleatman, MD (retired) · Answer

You describe intermittent pain and discomfort with eating.  These are not the symptoms of gastroesophageal reflux.  You say that your surgeon says "my stomach is going into my esophagus due to a severe hiatal hernia."  That makes no sense.  I assume you mis-typed, and mean that your stomach is going into your CHEST.  I agree with the other surgeons that proper repair of the hernia involves mobilizing the esophagus into the chest, and making sure that, at the end of the operation, there is no tension on the repair.But all of this is "doctor stuff," and doesn't help with your decision.  You need to figure out exactly what is causing your symptoms.  If there really is some sort of twisting of the stomach due to the hiatal hernia, simple repair of the hernia and straightening out the stomach may solve your problem.Most patients with a sleeve stricture also complain of severe reflux.  If you really have this, then conversion to gastric bypass (along with repair of the hernia) may be your best bet.  But if you are dead set on not having a gastric bypass, it may be worth doing some more investigation to determine what is the exact cause of your problem.  It might even be worth trying to fix the hiatal hernia and see if that helps; you can always go back later for a conversion to bypass if you don't get relief from the hiatal hernia repair.

Hiatal hernia repair or revision to a gastric bypass along with hernia repair?

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