A Mooney, MD, A Rathi, BS, M Murr, MD, J P Gonzalvo, DO. University of South Florida, TGH
Introduction: Hiatal hernias (HH) are identified in 40% of bariatric surgery patients. We aimed to analyze the impact of endoscopic findings during routine preop endoscopy on rates of repairing hiatal hernia during bariatric surgery.
Methods: The records of 515 consecutive patients who underwent endoscopy from 2013-2016 in preparation for primary bariatric surgery were analyzed. Prevalence of HH, defined as a hiatal defect twice the scope size (> 2 cm) on retroflexion, was derived based on EGD findings. We calculated rates of hiatal hernia repair (HHR) correlated with EGD findings for each group. We also calculated the number of patients that underwent HHR without EGD findings consistent with HH.
Results:The groups consisted of 268 RYGB and 247 SG patients. Average age was 45 (SD = 11.5). Average BMI was 47 (SD = 8.87). Upper endoscopy evaluation identified HH in 289 patients (56%; RYGB = 149, SG = 140). Intra-op repair of HH was undertaken in 22 RYGB patients (8%) and in 134 SG patients (54%). The rate of HHR by intraoperative identification alone was less in the RYGB group, 1, compared to 43 in SG. The rate of HHR with a positive EGD was 7.8% in RYGB and 37% in SG. The rate of HHR with a negative EGD was 0.4% in RYGB and 17% in SG. The rate of no HHR with a positive EGD was 48% in RYGB and 20% in SG. The rate of no HHR with a negative EGD was 44% in RYGB and 26% in SG. A positive EGD led to a significantly higher rate of HHR than intraoperative assessment alone in the SG patients.
Conclusion: Hiatal hernias are common in bariatric patients. A standard for preoperative evaluation for weight loss surgery has been elusive. HH is a risk factor for reflux, and GERD is the most common complication after SG. Preoperative evaluation for HH should be the standard, and EGD reliably predicts repair. Although EGD may overestimate the presence of HH, we recommend routine endoscopy to identify and prepare the surgeon for HHs that will be missed on intraoperative evaluation alone.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80788
Program Number: P571
Presentation Session: Poster (Non CME)
Presentation Type: Poster