The Gastric Migration Crisis in Obesity Surgery
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The term intra-thoracic migration of the stomach (ITM) has been applied for postoperative hiatal hernias after laparoscopic sleeve gastrectomy (LSG). ITM is underrecognized because symptoms are often unspecific when they relate to entrapment rather than reflux. ITM is also underreported  because of the infrequent use of (3D)-CT which is the best method to detect staple lines above the diaphragm. Many obesity surgeons are not fully aware of the increasing numbers of ITM and the challenges associated with its prevention and therapy.
Post-bariatric ITM results from persistence or progression of a pre-existing hiatal hernia or from de novo formation. The mechanisms responsible for this outcome are not well understood but they appear to differ from the mechanisms leading to hiatal hernias in the non-obese population. A gastric sleeve is not much wider than the esophagus itself and can easily be drawn through the hiatus. This may be facilitated by the melt down of visceral and hiatal fat....
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