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

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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.

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Authors and Affiliations

  1. Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Israel

    Shlomi Rayman, Michael Goldenshluger, Joseph Dux & David Goitein

  2. Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel

    Orly Goitein

  3. Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel

    Nasser Sakran, Asnat Raziel & David Goitein

  4. Department of Surgery A, Emek Medical Center, Afula, Israel

    Nasser Sakran

  5. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Shlomi Rayman, Michael Goldenshluger, Orly Goitein, Joseph Dux & David Goitein

  6. Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel

    Nasser Sakran

Authors
  1. Shlomi Rayman
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  2. Michael Goldenshluger
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  4. Joseph Dux
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  5. Nasser Sakran
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  6. Asnat Raziel
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  7. David Goitein
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Correspondence to David Goitein.

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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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Rayman, S., Goldenshluger, M., Goitein, O. et al. Conversion for failed adjustable gastric banding warrants hiatal scrutiny for hiatal hernia. Surg Endosc 33, 2231–2234 (2019). https://doi.org/10.1007/s00464-018-6509-1

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  • DOI: https://doi.org/10.1007/s00464-018-6509-1

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