{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T12:44:00Z","timestamp":1763729040445,"version":"3.44.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T00:00:00Z","timestamp":1750032000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T00:00:00Z","timestamp":1750032000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Minimally invasive hiatal hernia repair with fundoplication (HHR) is the standard of care for hiatal hernias but has a high risk of recurrence even in populations without obesity. Concomitant roux-en-y gastric bypass (RYGB) with HHR may mitigate the increased risk of hiatal hernia recurrence in patients with obesity while also addressing obesity-related comorbidities. There is a paucity of data on this procedure. It is hypothesized that a concomitant RYGB with HHR is safe and effective in patients with obesity.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This is a single institution retrospective review of adult patients who underwent concomitant RYGB with HHR from 2014\u20132023. Patient charts were reviewed to collect data on complications, weight loss, GERD symptom resolution, and improvement in other obesity-related comorbidities. Outcomes were measured at one-, three-, and five-year follow-up.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Sixty-four patients met inclusion criteria. Fifty-three patients had primary and eleven patients had revisional surgery. There was one (2%) perioperative complication that required intervention, three (4%) unplanned readmissions for PO intolerance, and four patients (8%) treated for marginal ulcer. Resolution of heartburn\/reflux symptoms was 86% at one year, 70% at 3\u00a0year, and 59% at 5\u00a0year follow-up. Improvement in diabetes (80%), hypertension (75%), and hyperlipidemia (33%) were noted at 5\u00a0years. The change in BMI and %TWL at 5\u00a0years for primary procedures was -11.5\u00a0kg\/m<jats:sup>2<\/jats:sup> and 37.7%, respectively. For revisional procedures, change in BMI was -2.4\u00a0kg\/m<jats:sup>2<\/jats:sup> and %TWL was 3.6%.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Durability of a HHR in the setting of obesity is poor. Concomitant RYGB with HHR is safe and effective for treating GERD while also improving obesity and obesity-associated comorbidities.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00464-025-11854-7","type":"journal-article","created":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T12:39:50Z","timestamp":1750077590000},"page":"4801-4805","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Concurrent hiatal hernia repair and gastric bypass as an adjunct in the treatment of hiatal hernia in populations with obesity"],"prefix":"10.1007","volume":"39","author":[{"given":"Leon","family":"Siegel","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rory","family":"Carroll","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dakota T.","family":"Thompson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan","family":"Lehmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0130-6103","authenticated-orcid":false,"given":"Peter","family":"Nau","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,6,16]]},"reference":[{"key":"11854_CR1","unstructured":"Smith RE, Sharma S, Shahjehan RD (2024) Hiatal hernia. [Updated 2024 Jul 17]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK562200\/"},{"issue":"1","key":"11854_CR2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgast-2020-000565","volume":"8","author":"J Kim","year":"2021","unstructured":"Kim J, Hiura GT, Oelsner EC, Yin X, Barr RG, Smith BM, Prince MR (2021) Hiatal hernia prevalence and natural history on non-contrast CT in the multi-ethnic study of atherosclerosis (MESA). BMJ Open Gastroenterol 8(1):e000565","journal-title":"BMJ Open Gastroenterol"},{"issue":"6","key":"11854_CR3","doi-asserted-by":"publisher","first-page":"1069","DOI":"10.1097\/XCS.0000000000001040","volume":"238","author":"SR DeMeester","year":"2024","unstructured":"DeMeester SR, Bernard L, Schoppmann SF, McKay SC, Roth JS (2024) Updated Markov model to determine optimal management strategy for patients with paraesophageal hernia and symptoms, cameron ulcer, or comorbid conditions. J Am Coll Surg 238(6):1069\u20131082","journal-title":"J Am Coll Surg"},{"key":"11854_CR4","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-024-11092-3","author":"S Daly","year":"2024","unstructured":"Daly S, Kumar SS, Collings AT, Hanna NM, Pandya YK, Kurtz J, Kooragayala K, Barber MW, Paranyak M, Kurian M, Chiu J, Ansari MT, Slater BJ, Kohn GP (2024) SAGES guidelines for the surgical treatment of hiatal hernias. Surg Endosc. https:\/\/doi.org\/10.1007\/s00464-024-11092-3","journal-title":"Surg Endosc"},{"issue":"1","key":"11854_CR5","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1177\/26345161221137089","volume":"3","author":"BM Till","year":"2023","unstructured":"Till BM, Mack SJ, Whitehorn G, Collins ML, Yang CJ, Grenda T, Evans NR, Okusanya O (2023) The epidemiology of surgically managed hiatal hernia: a nine year review of national trends. Foregut 3(1):20\u201328","journal-title":"Foregut"},{"issue":"4","key":"11854_CR6","first-page":"481","volume":"244","author":"BK Oelschlager","year":"2006","unstructured":"Oelschlager BK, Pellegrini CA, Hunter J, Soper N, Brunt M, Sheppard B, Jobe B, Polissar N, Mitsumori L, Nelson J, Swanstrom L (2006) Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg 244(4):481\u2013490","journal-title":"Ann Surg"},{"issue":"2","key":"11854_CR7","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.sopen.2019.06.004","volume":"1","author":"R Ellis","year":"2019","unstructured":"Ellis R, Garwood G, Khanna A, Harmouch M, Miller CC, Banki F (2019) Patient-related risk factors associated with symptomatic recurrence requiring reoperation in laparoscopic hiatal hernia repair. Surg Open Sci 1(2):105\u2013110","journal-title":"Surg Open Sci"},{"issue":"5","key":"11854_CR8","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1001\/jamasurg.2015.25","volume":"150","author":"AO Lidor","year":"2015","unstructured":"Lidor AO, Steele KE, Stem M, Fleming RM, Schweitzer MA, Marohn MR (2015) Long-term quality of life and risk factors for recurrence after laparoscopic repair of paraesophageal hernia. JAMA Surg 150(5):424\u2013431","journal-title":"JAMA Surg"},{"issue":"3","key":"11854_CR9","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1053\/j.gastro.2005.12.016","volume":"130","author":"JE Pandolfino","year":"2006","unstructured":"Pandolfino JE, El-Serag HB, Zhang Q, Shah N, Ghosh SK, Kahrilas PJ (2006) Obesity: a challenge to esophagogastric junction integrity. Gastroenterology 130(3):639\u2013649","journal-title":"Gastroenterology"},{"issue":"3","key":"11854_CR10","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1007\/s11605-007-0097-z","volume":"11","author":"FA Herbella","year":"2007","unstructured":"Herbella FA, Sweet MP, Tedesco P, Nipomnick I, Patti MG (2007) Gastroesophageal reflux disease and obesity. Pathophysiology and implications for treatment. J Gastrointest Surg 11(3):286\u2013290","journal-title":"J Gastrointest Surg"},{"issue":"5","key":"11854_CR11","doi-asserted-by":"publisher","first-page":"w822","DOI":"10.1377\/hlthaff.28.5.w822","volume":"28","author":"EA Finkelstein","year":"2009","unstructured":"Finkelstein EA, Trogdon JG, Cohen JW, Dietz W (2009) Annual medical spending attributable to obesity: payer-and service-specific estimates: amid calls for health reform, real cost savings are more likely to be achieved through reducing obesity and related risk factors. Health Aff (Millwood) 28(5):w822\u2013w831","journal-title":"Health Aff (Millwood)"},{"issue":"9","key":"11854_CR12","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1007\/s004640000392","volume":"15","author":"AR Perez","year":"2001","unstructured":"Perez AR, Moncure MA, Rattner DW (2001) Obesity adversely affects the outcome of antireflux operations. Surg Endosc 15(9):986\u2013989","journal-title":"Surg Endosc"},{"issue":"11","key":"11854_CR13","doi-asserted-by":"publisher","first-page":"1978","DOI":"10.1007\/s00464-007-9490-7","volume":"21","author":"CB Morgenthal","year":"2007","unstructured":"Morgenthal CB, Lin E, Shane MD, Hunter JG, Smith CD (2007) Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes. Surg Endosc 21(11):1978\u20131984","journal-title":"Surg Endosc"},{"key":"11854_CR14","unstructured":"Centers for Disease Control and Prevention (2022) Adult obesity facts. Overweight & obesity. https:\/\/www.cdc.gov\/obesity\/data\/adult.html. Last updated 5\/17\/2022."},{"issue":"1","key":"11854_CR15","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1007\/s00464-019-07231-w","volume":"34","author":"P Nau","year":"2020","unstructured":"Nau P, Jackson HT, Aryaie A, Ibele A, Shouhed D, Lo Menzo E, Kurian M, Khaitan L (2020) SAGES foregut task force white paper. Surgical management of gastroesophageal reflux disease in the obese patient. Surg Endosc 34(1):450\u2013457","journal-title":"Surg Endosc"},{"issue":"3","key":"11854_CR16","first-page":"533","volume":"104","author":"MD Crowell","year":"2009","unstructured":"Crowell MD, Bradley A, Hansel S et al (2009) Obesity is associated with increased 48-h esophageal acid exposure in patients with symptomatic gastroesophageal reflux. Am J of Gastro 104(3):533\u2013559","journal-title":"Am J of Gastro"},{"issue":"6","key":"11854_CR17","doi-asserted-by":"publisher","first-page":"1349","DOI":"10.1111\/j.1572-0241.2008.01909.x","volume":"103","author":"DR De Vries","year":"2008","unstructured":"De Vries DR, Van Herwaarden MA, Smout AJ, Samson M (2008) Gastroesophageal pressure gradients in gastroesophageal reflux disease \u2013 relations with hiatal hernia, body mass index, and esophageal acid exposure. Am J of Gastro 103(6):1349\u20131354","journal-title":"Am J of Gastro"},{"issue":"8","key":"11854_CR18","doi-asserted-by":"publisher","first-page":"1653","DOI":"10.1016\/j.cgh.2019.08.019","volume":"18","author":"BD Rogers","year":"2020","unstructured":"Rogers BD, Patel A, Wang D, Sayuk GS, Gyawali CK (2020) Higher esophageal symptom burden in obese subjects results from increased esophageal acid exposure and not from dysmotility. Clin Gastro and Hep 18(8):1653\u20131657","journal-title":"Clin Gastro and Hep"},{"issue":"4","key":"11854_CR19","doi-asserted-by":"publisher","first-page":"525","DOI":"10.33549\/physiolres.935067","volume":"72","author":"Y Yang","year":"2023","unstructured":"Yang Y, Lin JR, Li YQ, Wei YS, Duan ZJ (2023) Effect of body weight and obesity on esophageal function. Physiol Res 72(4):525\u2013537","journal-title":"Physiol Res"},{"issue":"6","key":"11854_CR20","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.1111\/j.1572-0241.2005.41703.x","volume":"100","author":"H El-Serag","year":"2005","unstructured":"El-Serag H, Graham DY, Satia J, Rabeneck L (2005) Obesity is an independent risk factor for gerd symptoms and erosive esophagitis. Am J of Gastro 100(6):1243\u20131250","journal-title":"Am J of Gastro"},{"issue":"3","key":"11854_CR21","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1016\/j.soc.2009.03.010","volume":"18","author":"L Murray","year":"2009","unstructured":"Murray L, Romero Y (2009) Role of obesity in Barret\u2019s esophagus and cancer. Surg Onc Clinics of North America 18(3):439\u2013452","journal-title":"Surg Onc Clinics of North America"},{"key":"11854_CR22","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-024-10839-2","author":"W Wang","year":"2024","unstructured":"Wang W, Liu Q, Luo L, Huang J, Hu X et al (2024) Value of endoscopic grading of gastroesophageal flap valve in gastroesophageal reflux disease. Surg Endosc. https:\/\/doi.org\/10.1007\/s00464-024-10839-2","journal-title":"Surg Endosc"},{"issue":"6","key":"11854_CR23","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1016\/j.jamcollsurg.2020.03.011","volume":"230","author":"AR Saad","year":"2020","unstructured":"Saad AR, Velanovich V (2020) Anatomic observation of recurrent hiatal hernia: recurrence or disease progression? J Am Coll Surg 230(6):999\u20131007","journal-title":"J Am Coll Surg"},{"issue":"3","key":"11854_CR24","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1007\/s11605-011-1743-z","volume":"16","author":"BK Oelschlager","year":"2012","unstructured":"Oelschlager BK, Petersen RP, Brunt LM, Soper NJ, Sheppard BC, Mitsumori L, Rohrmann C, Swanstrom LL, Pellegrini CA (2012) Laparoscopic paraesophageal hernia repair: defining long-term clinical and anatomic outcomes. J Gastrointest Surg 16(3):453\u2013459","journal-title":"J Gastrointest Surg"},{"issue":"10","key":"11854_CR25","doi-asserted-by":"publisher","first-page":"7642","DOI":"10.1007\/s00464-023-10212-9","volume":"37","author":"AR Ibele","year":"2023","unstructured":"Ibele AR, Nau PN, Galvani C, Roth JS, Goldberg RF, Kurian MS, Khaitan L, Gould J, Pandya YK (2023) SAGES foregut taskforce. Surgeon experience with insurance barriers to offering gastric bypass as an evidence-based operation for pathologic GERD. Surg Endosc 37(10):7642\u20137648","journal-title":"Surg Endosc"},{"key":"11854_CR26","doi-asserted-by":"publisher","first-page":"2734","DOI":"10.1007\/s11695-023-06726-9","volume":"33","author":"K Hage","year":"2023","unstructured":"Hage K, Cornejo J, Allotey JK et al (2023) Feasibility and outcomes of simultaneous gastric bypass with paraesophageal hernia repair in elderly patients. Obes Surg 33:2734\u20132741","journal-title":"Obes Surg"},{"key":"11854_CR27","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1016\/j.soard.2014.02.004","volume":"10","author":"UI Chaudhry","year":"2014","unstructured":"Chaudhry UI, Marr BM, Osayi SN, Mikami DJ, Needleman BJ, Melvin WS, Perry KA (2014) Laparoscopic roux-en-y gastric bypass for treatment of paraesophageal hernia in the morbidly obese: medium-term results. Surg for Obes and Related Dis 10:1063\u20131069","journal-title":"Surg for Obes and Related Dis"},{"issue":"1","key":"11854_CR28","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1016\/j.soard.2020.08.035","volume":"17","author":"KH Lewis","year":"2021","unstructured":"Lewis KH, Callaway K, Argetsinger WJ, Arterburn DE, Zhang F, Fernandez A, Ross-Degnan D, Dimick JB, Wharam JF (2021) Concurrent hiatal hernia repair and bariatric surgery: outcomes after sleeve gastrectomy and Roux-en-Y gastric bypass. Surg for Obes and Related Dis 17(1):72\u201380","journal-title":"Surg for Obes and Related Dis"}],"container-title":["Surgical Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-025-11854-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00464-025-11854-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-025-11854-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,6]],"date-time":"2025-09-06T20:06:56Z","timestamp":1757189216000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00464-025-11854-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,16]]},"references-count":28,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["11854"],"URL":"https:\/\/doi.org\/10.1007\/s00464-025-11854-7","relation":{},"ISSN":["0930-2794","1432-2218"],"issn-type":[{"type":"print","value":"0930-2794"},{"type":"electronic","value":"1432-2218"}],"subject":[],"published":{"date-parts":[[2025,6,16]]},"assertion":[{"value":"24 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 June 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Dr. Leon Siegel, Dr. Rory Carroll, Dr. Dakota Thompson, Dr. Ryan Lehmann, Dr. Jessica Smith, and Dr. Peter Nau have no conflicts of interest to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosure"}}]}}