Study context and its limits
Study-team evidence, not a personal surgeon outcome rate. Groups may overlap with other publications; do not add their patient counts.
Study sample reported in this source record: six hundred ninety-five patients. This is not necessarily the denominator for every outcome.
Reported recruitment period / follow-up: January 2015–May 2016
Recorded author position: first. Authorship does not establish who performed each operation.
Background: obesity is a risk factor for gastro-esophageal disease (GERD) and hiatal hernia (HH) occurrence.
A substantial number of obese patients have HH.
Esophago-gastro-duodenoscopy (EGD) and Barium X-ray oral study are used for preoperative gastrointestinal evaluation.
Not all HH can be diagnosed before surgery, some are discovered during laparoscopic sleeve gastrectomy (LSG).
Aim to assess the possible correlations between intraoperative presence of hiatal hernia (known or new discovered) and preoperative clinical, radiological and endoscopic data specific for GERD and HH.
Setting single institution Ponderas Academic Hospital, Center of Excellence in Bariatric and Metabolic Surgery.
Material and Methods: The prospectively maintained database of the institution was retrospectively quired to identify all the patients who underwent primary Laparoscopic Sleeve Gastrectomy (LSG) without/with concomitant hiatal hernia (HH) repair between January 2015 to May 2016.
Patient characteristics, co-morbidities, GERD symptoms, radiologic oral contrast study, endoscopy and operative details were analyzed.
Results: six hundred ninety-five patients (260 male and 435 female) were identified meeting inclusion criteria (LSG +- HH repair).
Mean age of patients was 41 +- 11.71years and average body mass index (BMI) was 41.96 +- 7.28 kg/m2.
Preoperative upper gastrointestinal contrast series and endoscopy were performed for entire group study and demonstrated a hiatal hernia in 339 patients (48.78%).
In all these cases, HH was repaired concomitantly with LSG.
One hundred ninety-two patients (56.63%) were diagnosed with HH before operation and confirmed intraoperatively (Group A).
The diagnosis of hiatal hernia was established intraoperatively for 147 patients (43.37%) – group B, using the surgical protocol for active identification of preoperative undiagnosed hiatal hernia – SPAIH.
Conclusion preoperative investigations such as EGD and barium X-ray oral study are suboptimal in diagnosing HH, therefore, in a significant number of patients, the presence of HH has been established using our surgical protocol – SPAIH.
Crura approximation (HHR) concomitantly with laparoscopic sleeve gastrectomy is reproducible, may prevent the HH progression and possible GERD complications in the postoperative period of time.
Source for this statement
denominator
six hundred ninety-five patients (260 male and 435 female) were identified meeting inclusion criteria (LSG +- HH repair).
Supporting source
Limits of interpretation
Retrospective detection study, not weight-loss or surgical complication-rate evidence.
The 43.37% denominator is 339 hernia patients, not all sleeve patients.
Abstract sequence on preoperative diagnosis is confusing; use explicit group definition.