Outcomes of Concomitant Laparoscopic Crural Repair of Hiatal Hernia with Sleeve Gastrectomy: Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Abstract Background Hiatus hernia (HH) is prevalent among patients with obesity. Concurrent repair is often performed during bariatric surgeries, but a consensus on the safety and effectiveness of concurrent HH repair (HHR) and bariatric surgeries remains unclear. This systematic review was conducted to investigate the effectiveness and clinical outcomes of laparoscopic sleeve gastrectomy (LSG) when performed concurrently with crural repair of hiatal hernia in patients with obesity. Methods A systematic search of PubMed, Cochrane, and Embase was performed to find all the relevant articles. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa scale. The primary outcomes were postoperative GERD rate, esophagitis, and weight loss. Secondary outcomes included effect on comorbidity prevalence, postoperative complications, and mortality. The PRISMA guidelines were used to carry out the present systematic review. Meta-analyses were performed using the Review Manager software. Results Twenty-five articles with a total of 163,766 patients; 72,287 in the LSG with HHR (group-1) and 91,479 in the LSG without HHR (group-2), met the inclusion criteria and included in the meta-analyses. In group-1, 59.4 % of subjects presented with clinical GERD symptoms preoperatively compared to only 35.6 % postoperative (p < 0.001). The study reported also a significant reduction in the risk of esophagitis by 73% after the operation. The post operative GERD in group-1 (21.3%) was insignificantly lower than that of the group-2 (23.5%) since p = 0.34, while the de novo GERD in group-1 (13%) was significantly lower than that in group-2 (25.5%) since p = 0.0001. However, the post-operatively proton pump inhibitors use was significantly higher in group-1 (13.7%) compared to (10.5%) among the group-2. The mean %EWL, and mean %TWL were similar between the two operations (p = 0.81 and 0.49 respectively). The rate of bleeding was 0.64% and 0.71% in group-1 and group-2, respectively (p = 0.42). Post operative interventions were similar between the 2 operations (p = 0.85). Conclusions This study revealed that both LSG with concomitant HHR and without are effective in terms of reflux resolution and weight outcomes, with superiority of LSG + HHR in terms of GERD control. Both strategies can therefore be suggested in subjects with obesity and concomitant hiatal hernia and/or GERD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.028 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.033 |
| Bibliometrics | 0.007 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".