• Surg Obes Relat Dis · Feb 2017

    Observational Study

    Barium swallow for hiatal hernia detection is unnecessary prior to primary sleeve gastrectomy.

    • David Goitein, Nasser Sakran, Shlomi Rayman, Amir Szold, Orly Goitein, and Asnat Raziel.
    • Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel. Electronic address: david.goitein@sheba.health.gov.il.
    • Surg Obes Relat Dis. 2017 Feb 1; 13 (2): 138-142.

    BackgroundHiatal hernia (HH) is common in the bariatric population. Its presence imposes various degrees of difficulty in performing laparoscopic sleeve gastrectomy (LSG). Preoperative upper gastrointestinal evaluation consists of fluoroscopic and or endoscopic studies OBJECTIVES: To evaluate the efficacy of routine, preoperative barium swallow in identifying HH in patients undergoing LSG, and determine if such foreknowledge changes operative and immediate postoperative course regarding operative time, intraoperative adverse events, and length of hospital stay (LOS). In addition, to quantify HH prevalence in these patients and correlate preoperative patient characteristics with its presence.SettingHigh-volume bariatric practice in a private hospital in Israel METHODS: Retrospective analysis of prospectively collected data between October 2010 and March 2015: anthropometrics, co-morbidities, previous barium swallow, preoperative HH workup (type and result), operative and immediate postoperative course.ResultsPrimary LSG was performed in 2417 patients. The overall prevalence of HH was 7.3%. Preoperative diagnosis of gastroesophageal reflux disease and female gender were independent risk factors for HH presence. Operative times were significantly longer when HH was concomitantly repaired but "foreknowledge" thereof did not assist in shortening this time. Looking for an HH that was suggested in preoperative upper gastrointestinal evaluation slightly prolonged surgery. LOS was not changed in a significant fashion by HH presence and repair, whether suspected or incidentally found.ConclusionRoutine, pre-LSG barium swallow does not seem to offer an advantage over selective intraoperative hiatal exploration, in the discovery and management of HH. Conversely, when preoperative workup yields a false-positive result, surgery is slightly prolonged.Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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