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Journal of Hepato-Gastroenterology

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Gastroesophageal fat pad has no clinical significance in patients with GERD, giant hiatus hernia and in repeat surgery

Author(s): Mihael Sok*, Miha Zavrl and Tomaz Stupnik

BACKGROUND: The objective of the study was to assess the clinical significance of evident gastroesophageal fat pad (EGFP) in patients operated on for gastroesophageal reflux disease (GERD), giant hiatal hernia (HH) types III and IV and repeat surgery for recurrent hernia.

METHODS: Data about EGFP were prospectively evidenced at operation. An EGFP was defined as a well encapsulated lipoma-like lipidic tissue more than 2 cm in its small diameter, not covered with peritoneum. A group of 119 patients receiving surgery for either GERD and HH. Patients with repeat operations were also included in the study. The preferred operations were laparoscopic Toupet and Nissen fundoplication.

RESULTS: In total 49% of patients presented with an EGFP, 46% from the GERD group and 53% from the HH group. The presence of EGFP did not affect the symptoms of GERD. Number of stiches as indirect evaluation of hernia size was practically equal in patients with and without EGFP. A positive correlation was observed between EGFP and BMI of the patients. Of 119 patients, 12 patients received repeat surgery. In this group an EGFP was found in six cases (50%).

CONCLUSION: An EGFP was present in 49% of all studied patients and in 50% of the patients receiving reoperation. Patients with higher BMI had significantly more EGFP (p=0.001). An EGFP were not associated with the clinical manifestation of GERD and the size of HH. An EGFP resected from mediastinum and left intraabdominally is not associated with incidence of hernia recurrence.

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