P1.022. Hiatal Hernia in Gastric Bypass Patients: A Systematic Review and Meta-analysis Background

Abstract

Abstract Topic Benign Disease: Esophageal Surgery Background The optimal management of hiatal hernia during or after gastric bypass remains unclear, with limited evidence and no established guidelines. Methods This systematic review and meta-analysis was preregistered in PROSPERO (ID: 42025640966) and conducted according to PRISMA guidelines. PubMed and Embase were searched from inception to January 2025. Studies reporting outcomes of hiatal hernia repair during or after gastric bypass were included. Two clinical questions were addressed: outcomes of concomitant repair during gastric bypass and management after previous gastric bypass. Results A total of 3,135 studies were identified; six studies (99 patients) on concomitant repair and 23 on post-RYGB management were included. In the concomitant group, most patients had large type III–IV hiatal hernias. The pooled overall complication rate was 19.2%, with serious complications (Clavien–Dindo ≥IIIb) in 5.4%. Reoperation rates ranged from 0.7% to 1.5%, and mortality from 0% to 0.5%. Symptom outcomes were inconsistently reported, and complete reflux resolution was not universal.In patients undergoing surgery after previous RYGB, the most common indications were reflux, dysphagia, and epigastric pain. Surgical repair based on standard hiatal hernia principles was associated with favourable short-term outcomes, although the level of evidence was low. Conclusion Concomitant repair of large hiatal hernias during RYGB is feasible and appears justified, with low rates of serious complications, reoperation, and mortality despite procedural complexity. Evidence for revisional surgery after RYGB remains limited but suggests favourable short-term outcomes. High-quality prospective studies are warranted to guide surgical decision-making in this challenging population.