Hiatal Hernia Evaluation Before Bariatric Surgery: Should It Be Routinely Done?
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ORIGINAL CONTRIBUTIONS
Hiatal Hernia Evaluation Before Bariatric Surgery: Should It Be Routinely Done? Ashraf Imam 1 & George Asfour 2 & Riham Imam 1 & Avital Bilitzky-Kopit 2 & Guy Pines 2,3 & Shimon Sapojnikov 4 & Harbi Khalayleh 2 Received: 26 June 2020 / Revised: 23 October 2020 / Accepted: 26 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose The necessity of routine preoperative esophagogastroduodenoscopy (EGD) and upper gastrointestinal series (UGIS) in the evaluation of hiatal hernia (HH) among bariatric surgery candidates is controversial since most are detected during surgery, regardless of the preoperative work-up. The aim is to determine the accuracy of preoperative EGD and UGIS for HH diagnosis among bariatric surgery candidates. Material and Methods The records of bariatric surgery patients between 2011 and 2015 were reviewed. Patients underwent routine UGIS and/or EGD before the surgery. The positive and negative predictive values (PPV, NPV) for each study were calculated based on operative findings. Results A total of 463 patients were included in the study. Mean age was 44.34 ± 12.99 years. Mean preoperative body mass index (BMI) was 42.7 ± 5.15 kg/m2. A total of 450 patients (97.2%) had a UGIS, 263 patients underwent EGD (56.8%), and 258 (55.7%) patients had both tests. HH was diagnosed in 26 (5.8%), 60 (13%), and 72 (27.8%) patients, respectively. HH was found intra-operatively in 53 patients (11.4%). It was associated with heartburn (P = 0.005) and previous bariatric surgery (P = 0.008). EGD had a greater sensitivity than UGIS (47.4% vs. 30.2%) and a lower specificity (81.4% vs. 97.5%). PPV and NPV for UGIS and EGD were 61.5% and 91.3% vs. 30% and 90.2%, respectively. The sensitivity of both tests when combined together reached 60.5%. Conclusions Both EGD and UGIS, whether solely performed or combined, have low sensitivity for diagnosis of HH and can probably be omitted from the preoperative evaluation, except for high-risk patients. Keywords Hiatus hernia . Laparoscopic gastric bypass . Laparoscopic sleeve gastrectomy . Endoscopy . Fluoroscopy
Introduction Obesity is a major health problem worldwide that is associated with variable comorbidities. Bariatric surgery accompanied
* Ashraf Imam [email protected] 1
Department of Surgery, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
2
Department of Surgery, Kaplan Medical Center, Rehovot and the Hebrew University Medical School, Jerusalem, Israel
3
Department of Thoracic Surgery, Kaplan Medical Center, Rehovot and The Hebrew University Medical School, Jerusalem, Israel
4
Department of Surgery, Rabin Medical Center and Tel Aviv University Sackler Medical School, Tel Aviv, Israel
by lifestyle and diet modifications is an effective way of its management [1]. One of the highly prevalent comorbidities in obese patients is HH and gastroesophageal reflux diseases (GERD) [2–6]. Meticulous preoperative evaluation of GERD and HH is paramount, as symptoms may worsen signi
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