GE junction abnormality during bariatric surgery. Laparoscopic View better than Endoscopic findings?

Sanjay M Patolia, Dr

Asian Bariatric

Introduction: Acceptance for Bariatric Surgery as most effective treatment for morbid obesity is increasing. Prolonged food intolerance may lead to nutritional deficiencies and neurological complications. Anatomical and physiological abnormality of Gastro esophageal junction in the form of Lax cardia, Hiatus Hernia and GERD are important factors which are responsible for prolonged food intolerance. Certain factors affect the accuracy of endoscopy findings and there are chances that endoscopy may miss the OG junction abnormality. Laparoscopic view (ABSENCE OF HANGING FAT PAD AT ANGLE OF HIS either or PRESENCE OF VISIBLE DEFECT ANTERIOR TO ESOPHAGUS AT HIATUS) is important observational tool to diagnose OG junction abnormality more accurately for selecting right bariatric operation and for simultaneous crura repair.

Material & Method: Total 45 patients were included in this study group. All patients were screened by preoperative endoscopy and at the time of laparoscopic bariatric procedure. All the patients were subjected for hiatus dissection to evaluate the accuracy of both the parameters and to detect GE junction abnormalities.

Results:

Total Patients Positive UGD Positive lap.view
45 21(46.6%) 32(71.1%)
Large Hiatus opening > 2.5cm 20(44.44%) 31(68.88%)

Discussion: The acceptance for Sleeve Gastrectomy (SG) is increasing very high. It is very essential to assess and establish the anatomical and physiological abnormality of GE junction before any bariatric operations especially restrictive procedure like SG to avoid prolong food intolerance after surgery. Prolong food intolerance leads to nutritional deficiencies and neurological complications.

Accuracy of Endoscopy for the diagnosis of lax cardia, small hiatus hernia and GERD is evidence based and is affected by various factors like anxiety, over apprehension, poor compliance, inexperienced hands and procedure under short G/A.

Laparoscopic view (Large visible defect anterior to esophagus at hiatus opening, Absence of hanging fat pad at Angle of His) gives higher accuracy for the detection of lax cardia and small hiatus hernia.

However, esophageal manometry and Ph metry are believed to be best tool to diagnose abnormal GE junction.

Conclusion: Positive Laparoscopic view is more accurate to judge anatomical abnormality like lax cardia /Hiatus hernia. Consideration of both Endoscopic findings and laparoscopic observation can help to select the right bariatric procedure.


Session: Poster Presentation

Program Number: P472

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