A significant percentage of patients undergoing bariatric surgery have associated hiatal hernias. Morbid obesity is a risk factor for recurrence of hiatal hernia repairs. Pledgeted sutures may decrease the risk of hiatal hernia recurrence at time of bariatric operation with associated hiatal hernia repair.
When performing bariatric operations in our institution, we employ staple line reinforcement. We only reinforce the anvil side of the stapler leaving remaining material from each firing. We cut the remaining material into strips and use them as a pledget with 0-ethibond suture material for hiatal hernia repair. This does not impact our principle of having a tension free crural repair as well as reducing the gastroesophageal junction at least 3cm below the hiatus without pulling on the stomach.
We are tracking these patients to see if there is a reduction in hiatal hernia recurrence in patients that have had absorbable pledgets used as part of their repair.
Crural muscle can be attenuated. Hiatal hernia recurrence is a likely cause of postoperative gastroesophageal reflux. This is a no-added cost attempt at decreasing the shearing forces on the crural muscle fibers when approximating the crura with the hypothesis that this would reduce recurrence. The material used is identical to the material used in hiatal patches employed in non-bariatric hiatal hernia repairs. There is no added risk to the patient. Adding pledgets to the repair warrants long term followup to see if it results in decreased recurrence rates.