Treatment of morbid obesity and gastroesophageal reflux with hiatal herniaby Lap-Band

Background: Esophageal reflux is common in obese patients. Hiatal hernia is considered a potential contraindication to placement of a Lap-Band. Methods: Esophageal investigation in patients who were candidates for a Lap -Band included clinical evaluation of symptoms (scoring system), endoscopic and radiologic evaluation, 24-h pH test, and stationary manometry. Patient s with gastroesophageal reflux (GER) with or without hiatal hernia underwen t the Lap-Band procedure. Results: GER was diagnosed in 12/40 morbidly obese patients, 11 of whom rec eived a standard Lap-Band (3 patients were radiologically diagnosed with tr ansient hiatal hernia). One patient with a large hiatal hernia underwent cl osure of the diaphragmatic esophageal hiatus, and the Lap-Band was position ed similarly to an Angelchik prosthesis. AII but 1 patient who was lost at follow-up were symptom-free (range 1-24 months). Conclusion: GER with or without hiatal hernia is not a contraindication for obese patients undergoing a Lap-Band procedure. It accomplishes by a singl e operation satisfactory treatment of these two disturbing diseases.