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Surgical Endoscopy

, Volume 33, Issue 7, pp 2231–2234 | Cite as

Conversion for failed adjustable gastric banding warrants hiatal scrutiny for hiatal hernia

  • Shlomi Rayman
  • Michael Goldenshluger
  • Orly Goitein
  • Joseph Dux
  • Nasser Sakran
  • Asnat Raziel
  • David GoiteinEmail author
Article

Abstract

Background

Failure or complications following laparoscopic adjustable gastric banding (LAGB) may necessitate band removal and conversional surgery. Band position and band-induced chronic vomiting create ideal conditions for de novo hiatal hernia (HH) formation. HH presence impedes and complicates conversional surgery by obscuring crucial anatomical landmarks and hindering precise gastric sleeve or pouch formation. The aim of this study was to evaluate the incidence of a HH in patients with an LAGB undergoing conversion compared to patients undergoing primary bariatric surgery (BS).

Methods

Retrospective review of consecutive BS performed between 2010 and 2015. Data collected included demographics, anthropometrics, comorbidities, previous BS, preoperative and intra-operative HH detection, operation time, perioperative complications and length of hospital stay.

Results

During the study period, 2843 patients (36% males) underwent BS. Of these, 2615 patients (92%) were “primary” (no previous BS—control group), 197 (7%) had a previous LAGB (study group), and 31 (1%) had a different previous BS and were excluded. Reasons for conversion included weight regain, band intolerance and band-related complications. Mean age and body mass index were similar between the study and the control groups. HH was preoperatively diagnosed by upper gastrointestinal (UGI) fluoroscopy in 9.1% and 9.0% of the LAGB and control groups (p = NS), respectively. However, HH was detected intra-operatively in 20.3% and 7.3%, respectively (p < 0.0001).

Conclusions

Preoperative diagnosis of a HH by UGI fluoroscopy for patients who have undergone LAGB is unreliable. Intra-operative hiatal exploration is highly recommended in all cases of conversional BS after LAGB.

Keywords

Laparoscopic adjustable gastric banding UGI fluoroscopy Hiatal hernia Diaphragmatic hernia Sleeve gastrectomy Roux-Y gastric bypass Conversional surgery 

Notes

Compliance with ethical standards

Disclosures

Drs. S. Rayman, M. Goldenshluger, O. Goitein, J. Dux, N. Sakran, A. Raziel and D. Goitein have no financial or commercial conflicts of interest to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Surgery CChaim Sheba Medical CenterTel HashomerIsrael
  2. 2.Department of Diagnostic ImagingChaim Sheba Medical CenterTel HashomerIsrael
  3. 3.Assia Medical GroupAssuta Medical CenterTel AvivIsrael
  4. 4.Department of Surgery AEmek Medical CenterAfulaIsrael
  5. 5.Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
  6. 6.Rappaport Faculty of MedicineTechnion Israel Institute of TechnologyHaifaIsrael

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