Conversion for failed adjustable gastric banding warrants hiatal scrutiny for hiatal hernia

Shlomi Rayman, Michael Goldenshluger, Orly Goitein, Joseph Dux, Nasser Sakran, Asnat Raziel, David Goitein

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: Failure or complications following laparoscopic adjustable gastric banding (LAGB) may necessitate band removal and conversional surgery. Band position and band-induced chronic vomiting create ideal conditions for de novo hiatal hernia (HH) formation. HH presence impedes and complicates conversional surgery by obscuring crucial anatomical landmarks and hindering precise gastric sleeve or pouch formation. The aim of this study was to evaluate the incidence of a HH in patients with an LAGB undergoing conversion compared to patients undergoing primary bariatric surgery (BS). Methods: Retrospective review of consecutive BS performed between 2010 and 2015. Data collected included demographics, anthropometrics, comorbidities, previous BS, preoperative and intra-operative HH detection, operation time, perioperative complications and length of hospital stay. Results: During the study period, 2843 patients (36% males) underwent BS. Of these, 2615 patients (92%) were “primary” (no previous BS—control group), 197 (7%) had a previous LAGB (study group), and 31 (1%) had a different previous BS and were excluded. Reasons for conversion included weight regain, band intolerance and band-related complications. Mean age and body mass index were similar between the study and the control groups. HH was preoperatively diagnosed by upper gastrointestinal (UGI) fluoroscopy in 9.1% and 9.0% of the LAGB and control groups (p = NS), respectively. However, HH was detected intra-operatively in 20.3% and 7.3%, respectively (p < 0.0001). Conclusions: Preoperative diagnosis of a HH by UGI fluoroscopy for patients who have undergone LAGB is unreliable. Intra-operative hiatal exploration is highly recommended in all cases of conversional BS after LAGB.

Original languageEnglish
Pages (from-to)2231-2234
Number of pages4
JournalSurgical Endoscopy and Other Interventional Techniques
Volume33
Issue number7
DOIs
StatePublished - 15 Jul 2019
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2018, Springer Science+Business Media, LLC, part of Springer Nature.

Keywords

  • Conversional surgery
  • Diaphragmatic hernia
  • Hiatal hernia
  • Laparoscopic adjustable gastric banding
  • Roux-Y gastric bypass
  • Sleeve gastrectomy
  • UGI fluoroscopy

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