323 Optimising Hiatus Hernia Management After Bariatric Surgery: Outcomes of Laparoscopic Cruroplasty and Phrenoesophageal Ligament Reconstruction

Abstract Background Gastroesophageal reflux disease (GERD) is a frequent and challenging complication following bariatric surgery, often necessitating further intervention. While several surgical strategies exist, the optimal approach for symptomatic hiatus hernia post-bariatric surgery remains under debate. Method We retrospectively reviewed 11 patients who developed symptomatic GERD after bariatric procedures: 7 had undergone sleeve gastrectomy, 3 had a sleeve converted to gastric bypass for reflux, and 1 had a mini-gastric bypass. Presenting symptoms included retrosternal pain, interscapular discomfort, and dysphagia. All patients underwent comprehensive evaluation with upper GI endoscopy, 24-hour pH monitoring, and oesophageal manometry. Each underwent laparoscopic cruroplasty with meticulous oesophageal mobilisation and recreation of the phrenoesophageal ligament. Results All procedures were completed laparoscopically, with an average operative time of 74.6 minutes. The gastroesophageal junction was repositioned intra-abdominally and anchored to the crura. Two patients experienced transient left-sided pneumothorax, managed intraoperatively. Early postoperative follow-up demonstrated symptom control in 82.3% of patients, with sustained improvement in 79% at 18 months. Notably, proton pump inhibitor (PPI) dependence was markedly reduced, and GERD-Q scores improved most significantly in those with prior sleeve gastrectomy compared to gastric bypass. Conclusions Laparoscopic cruroplasty with phrenoesophageal ligament reconstruction is a safe, effective, and durable solution for hiatus hernia repair after bariatric surgery, offering substantial symptomatic relief and reduced medication dependence.