PARAESOPHAGEAL HERNIA REPAIR DURING BARIATRIC SURGERY - DOES SUB-SPECIALIZATION HAVE AN IMPACT: A MBSAQIP REVIEW OF 30-DAY OUTCOMES AND COMPLICATIONS | Poster Board #178

Purpose: Recently, bariatric and foregut surgery have become distinct entities under the minimally invasive surgery specialty, which has led some surgeons to subspecialize and focus solely on one or the other. There is currently a paucity of data to suggest this may lead to improved outcomes; therefore, the purpose of this study is to evaluate the outcomes of patients undergoing bariatric surgery and concurrent paraesophageal hernia repair (PEHR) by the same surgeon or by separate surgeons.
Materials and Methods: The 2015-2020 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Registry was used to evaluate patients undergoing laparoscopic sleeve gastrectomy (LSG) or Roux-en-y gastric bypass (RNYGB) and PEHR done by the same or by separate surgeons. Outcomes were evaluated using descriptive statistics and multivariable regression.
Results: A total of 142,799 patients underwent LSG or RNYGB with concurrent PEHR, 139,742 (98%) by the same surgeon and 2,767 (2%) done by separate surgeons. Patients with PEHR done by separate surgeons were younger 44.8y vs 46.8y, with a lower BMI 42.4kg/m² vs 43.4, greater proportion of males 485(17.5%) vs 21,972(15.6%) and white patients 2442(88.3%) vs 102,751(73.1%). Univariate analysis demonstrated reduced complications in patients undergoing PEHR by separate surgeon in both SG and RNYGB, albeit increased readmissions in those undergoing RNYGB Table 1. On multivariable regression, PEHR by a separate surgeon was independently associated with fewer reinterventions (OR 0.53, C.I. 0.31-0.90, p=0.019), reduced case duration (RC -4.216, p<0.001), and shorter length of stay (RC -0.174, p<0.001). While more readmissions were noted in the RNYGB group with PEHR performed by a separate surgeon, this was not significant on multivariable analysis.
Conclusion: In this national database study, concomitant bariatric surgery and PEHR by separate surgeons was associated with reduced operating time, shorter length of stay, and fewer reinterventions. While this study suggests a benefit with collaboration between bariatric surgeons and foregut surgeons; additional studies are needed to further evaluate the indication and specialty of the separate surgeon to refine the observed results.