• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Strategic Plan, 2020-2023
    • Committees
      • Descriptions and Video Updates
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • COVID-19 Announcements
    • SAGES 2020 Meeting Information
    • 2021 Scientific Session Call For Abstracts
    • 2021 Emerging Technology Session Call For Abstracts
    • 2018 Prevent BDI Consensus Conference
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • Leadership Development and Health Policy Conference Videos
      • SAGES Quality Summit Meeting
      • SAGES 2019
      • SAGES 2018
      • SAGES 2017
      • SAGES 2016
      • SAGES 2015
      • SAGES 2014
      • SAGES 2013
    • Related Meetings Calendar
  • Membership
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • COVID-19 Annoucements
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • Troubleshooting Guides
  • Education
    • SAGES.TV Video Library
    • Virtual Hernia Clinic
    • The SAGES Safe Cholecystectomy Program
    • The Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • The SAGES HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Endorsed Courses
    • SAGES Robotics Fellows Courses
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Educational Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES Quality Initiative
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • SAGES Research Opportunities
    • SAGES Endorsed Courses
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
    • Fellowship Certification
  • Search
    • COVID-19 Announcements
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Blog
    • All Blog Posts
    • COVID-19
    • Notes from the Battlefield
    • A (Positive) Way Forward
    • President Posts
  • Log In

Does Preoperative Ugi Predict Hiatal Hernia Presence During Laparoscopic Adjustable Band Placement?

Lane A Ritter, MD, Joseph Broucek, Minh Luu, MD, Khristi Autajay, RN LDN, Jonathan A Myers, MD. Rush University Medical Center

BACKGROUND
Hiatal hernia has long been an entity associated with morbid obesity. It has been reported that as many as 50% of upper gastrointestinal (UGI) series done prior to bariatric procedures reveal the presence of a hiatal hernia. Fifteen years ago, hiatal hernia was thought to be a contraindication to placement of a laparoscopic adjustable gastric band (LAGB); this was subsequently refuted and current practice is to perform both procedures concurrently, thus repairing the co-morbid hiatal hernia while placing the gastric band. There is continued controversy over the need for preoperative imaging prior to LAGB placement. It has been suggested that UGI studies should be done to rule out gross pathology while others have shown that this method of pan-fluoroscopy has a poor cost-benefit ratio. We have required routine preoperative UGI studies in our series of laparoscopic band placements; however, we consistently noticed that these radiologic reports were often not congruent with our intraoperative findings specifically in reference to presence of a hiatal hernia. We set out to determine the positive predictive value (PPV) of preoperative UGI series in diagnosing a hiatal hernia as compared to laparoscopic intraoperative diagnosis and intervention in our LAGB patients.
METHODS AND PROCEDURES
We carried out a retrospective review of a single surgeon’s experience with laparoscopic adjustable band placements spanning a period of 26 months. The series included a total of 147 patients; 83 had LAGB placements, 64 had LAGB placement with simultaneous hiatal hernia repair (HHR). All patients received a preoperative UGI series to evaluate for gross pathology. The decision to perform a HHR was based solely on intraoperative findings during pars flaccida dissection. If either an obvious hernia or dimpling between the right and left crus was observed, a crural repair was performed. Each patient’s preoperative UGI study was compared to the dictated operative report for presence of hiatal hernia. We also reviewed the patients’ initial preoperative consultation to determine which patients complained of subjective reflux symptoms or were taking anti-reflux medications.
RESULTS
Of 147 patients, 64 (44%) had intraoperative findings consistent with a hiatal hernia and received a crural repair. Of these 64 patients, only 32 (50%) had a preoperative UGI study that was read by an attending radiologist as demonstrating a hiatal hernia, creating a PPV of 50%. In turn, of the 83 patients who did not have an intraoperative hiatal hernia, 51 (61%) had a congruent UGI with no radiographic hiatal hernia, while 32 (39%) had a hiatal hernia according to the radiologic report; making the NPV 61%. We did not find a correlation in patient reported symptoms of reflux to either radiologic or intraoperative findings.
CONCLUSIONS
Upper gastrointestinal series has a poor PPV and NPV in preoperatively diagnosing the presence of hiatal hernia prior to LAGB placement. Subjective patient symptoms and need for anti-reflux medication had no direct correlation to either radiologic or intraoperative findings of hiatal hernia. Our results suggest that direct operative findings are the most accurate method of determining need for HHR during LAGB placement.


Session: Poster
Program Number: P027
View Poster

Post Views: 108

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2011 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Free SAGES Webinar: Lessons from COVID on Living and Thriving as Surgeons

SAGES recognizes that the COVID-19 pandemic has had a big impact on surgical practice and in surgeon wellness. SAGES’ Reimagining the Practice of Surgery Taskforce will present “Finding the Opportunities: Lessons from COVID and How We Live and Thrive as Surgeons”  to look at ways in which innovative leadership at various levels may help transform […]

Daniel Herron, MD

An opportunity to slow down and appreciate the small joys in life

Dan Herron, MD shares insights with Dana Telem, MD on lessons learned from COVID-19 Fear, anxiety and uncertainty has dominated the first half of 2020. Never before have we, as healthcare providers, been asked to do so much with so little—whether it’s resources like personal protective equipment, dusting off skills related to critical care, or […]

covid testing stock

Notes from the Battlefield – May 14, 2020

Coronavirus Global Surgical Collaborative (CVGSC)* An initiative sponsored by SAGES in collaboration with EAES, AEC, KSELS, and ELSA A group of surgical leaders from affected countries have joined to discuss what they are learning during this Covid-19 Global crisis. The following is a brief summary of what they feel may be useful information to disseminate to the surgical […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Newsletter Subscription

  • This field is for validation purposes and should be left unchanged.

Important Links

SAGES 2020 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

[footer_backtotop] · Log in

Copyright © 2021 Society of American Gastrointestinal and Endoscopic Surgeons · Legal
· Managed by BSC Management, Inc