CHECKLIST IN LAPAROSCOPIC SLEEVE GASTRECTOMY Part 3: CONSIDERATIONS HIATAL HERNIA
Aggressive identification of hiatal hernia intraoperatively Repair hiatal hernia if found
Close the diaphragmatic defect after the sleeve procedure is completed
EXPERT COMMENTARY
Kelvin Higa, MD, FACS, FASMBS University of California, San Francisco; Fresno Heart and Surgical Hospital; Advanced Laparoscopic Surgery Associates, Fresno, California
T
he recommendations of the SG consensus panel of experts on hernia repair are important because weight recidivism, proximal leaks, and late gastroesophageal reflux disease (GERD) can be related to imprecise proximal dissection and underestimating the importance of undiagnosed hiatal hernia at the time of performing a sleeve gastrectomy. It is
clear that endoscopy and contrast studies are not reliable at predicting the presence of hiatal hernias preoperatively; therefore, "aggressive" hiatal dissection with subsequent repair is recommended
X-ray image of a patient who developed a hiatal hernia after undergoing sleeve gastrectomy.
Ninh T. Nguyen, MD
University of California Irvine Medical Center, Irvine, California
SG consensus reports that GERD is the most prevalent complication observed after SG and is likely due to it being a high- pressure system. Therefore, a hiatal hernia should be repaired concomitantly with a sleeve gastrectomy. In my experience, small hiatal hernias can be closed with primary repair, while moderate and large hiatal hernias can be repaired posteriorly with an absorbable or biologic mesh in an effort to reduce postoperative hernia recurrence.
H
iatal hernia is commonly present in the morbidly obese. It is well known that up to 40 percent of patients undergoing bariatric surgery have a hiatal hernia identified on preoperative studies, such as upper gastrointestinal contrast studies or endoscopy. It is also well known that hiatal hernia contributes to the development of GERD. The
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[Bariatric Times JUNE 2012, SUPPLEMENT B]
