Routine Upper Gastrointestinal Fluoroscopy Before Laparoscopic Sleeve Gastrectomy: Is It Necessary?

AbstractBackgroundControversy exists regarding the clinical utility of routine preoperative upper gastrointestinal (GI) fluoroscopy in morbid obese patients undergoing laparoscopic sleeve gastrectomy (LSG). The aim of our study was to determine the efficacy of these studies in detecting hiatal hernias (HH).MethodsThe institution ’s prospectively maintained, IRB-approved database was retrospectively queried to identify all consecutive patients who underwent LSG between 2011 and 2017. All patients underwent routine preoperative upper GI fluoroscopy. Reports from all imaging studies were retrospectively reviewed and compared to the presence of an intraoperative HH.ResultsDuring the study period, a total of 1810 patients (854 males, 956 females) underwent LSG at our institution. Mean age was 40.95  ± 13 years (range 11–75), and mean BMI was 42.8 ± 5 kg/m2 (range 30 –86). The overall prevalence of HH was 11.1% (201 patients). All HHs detected were repaired. Considering the intraoperative identification of HH the gold standard for diagnosis, the sensitivity and specificity of preoperative UGI fluoroscopy for HH detection were 32% (66/201) and 94% (1512/1609), respectively. The median operative time was significantly longer when concomitant LSG and HH repair was performed compared to LSG alone (76 min vs. 55 min,p 
Source: Obesity Surgery - Category: Surgery Source Type: research

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Source: Hernia - Category: Sports Medicine Source Type: research
ConclusionA tailored approach is now employed and seen more so in hernia surgery and this fact is referred to and highlighted in the contemporaneous hernia guidelines published to date. In addition, with the increasing complexity of abdominal wall surgery, the number of procedures actually performed by trainees is no longer considered adequate to overcome any recognized learning curve. Therefore, to supplement general surgery training young surgeons should be offered a clinical fellowship to obtain an additional qualification as an abdominal wall surgeon and thus improve their clinical and operative experience under superv...
Source: Hernia - Category: Sports Medicine Source Type: research
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Source: Hernia - Category: Sports Medicine Source Type: research
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Source: Surgery for Obesity and Related Diseases - Category: Surgery Authors: Source Type: research
Paraesophageal and sliding-type hiatal hernias are extremely common in patients who suffer from obesity. Concomitant hernia repairs at the time of bariatric surgery have been reported in as high as 20% of all bariatric surgeries. Bioabsorbable tissue matrices have been used to bolster and enhance sutured paraoesophageal hernia defects and reduce local recurrences. To date there exists no large volume study assess outcomes of hiatus hernias repaired at the time of concomitant bariatric surgery, particularly with respect to the use of bioabsorbable tissue matrix.
Source: Surgery for Obesity and Related Diseases - Category: Surgery Authors: Source Type: research
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Source: Surgery for Obesity and Related Diseases - Category: Surgery Authors: Source Type: research
We present a case series of late term hiatal hernias after gastric bypass, and discuss the common presentation and treatment.
Source: Surgery for Obesity and Related Diseases - Category: Surgery Authors: Source Type: research
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Source: Surgery for Obesity and Related Diseases - Category: Surgery Authors: Source Type: research
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Source: Thoracic Surgery Clinics - Category: Cardiovascular & Thoracic Surgery Authors: Source Type: research
Paraesophageal hernias (PEH) are common among patients with obesity. Most patients with severe obesity and a PEH will have the PEH repaired at the time of bariatric surgery. However, it is unclear whether there is increased risk when repairing a PEH during bariatric surgery.
Source: Surgery for Obesity and Related Diseases - Category: Surgery Authors: Tags: Original articles Source Type: research
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