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Intrathoracic Pouch Migration in One-Anastomosis Gastric Bypass with and without Hiatoplasty – A 3D-CT Volumetry Study

  • Author Footnotes
    ∗ Both first authors (D.M. Felsenreich and M.A. Arnoldner) have contributed equally to this study
    D.M. Felsenreich
    Footnotes
    ∗ Both first authors (D.M. Felsenreich and M.A. Arnoldner) have contributed equally to this study
    Affiliations
    Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
    Search for articles by this author
  • Author Footnotes
    ∗ Both first authors (D.M. Felsenreich and M.A. Arnoldner) have contributed equally to this study
    M.A. Arnoldner
    Footnotes
    ∗ Both first authors (D.M. Felsenreich and M.A. Arnoldner) have contributed equally to this study
    Affiliations
    Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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  • L. Wintersteller
    Affiliations
    Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
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  • A. Mrekva
    Affiliations
    Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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  • J. Jedamzik
    Affiliations
    Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
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  • J. Eichelter
    Affiliations
    Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
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  • F.B. Langer
    Affiliations
    Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
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  • G. Prager
    Correspondence
    Corresponding author: Gerhard Prager, Univ. Prof. Dr. Professor for Bariatric and Metabolic Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria Phone: +43 1 40400 56210 Fax: +43 1 40400 56410
    Affiliations
    Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
    Search for articles by this author
  • Author Footnotes
    ∗ Both first authors (D.M. Felsenreich and M.A. Arnoldner) have contributed equally to this study
Published:November 18, 2022DOI:https://doi.org/10.1016/j.soard.2022.11.009

      Highlights

      • In primary OAGB, hiatoplasty was not associated with higher rates of intrathoracic pouch migration or GERD.
      • Generally, intrathoracic pouch migration is common after OAGB detected in 3D-CT volumetry and can lead to GERD.

      ABSTRACT

      Background

      Currently, 4.8% of bariatric operations worldwide are One-Anastomosis Gastric Bypass (OAGB) procedures. If a hiatal hernia is detected in a preoperative gastroscopy, OAGB can be combined with hiatoplasty. Intrathoracic pouch migration (ITM) is common after bypass procedures because the fundus, a natural abutment, is separated from the pouch.The aim of this study is to find out whether OAGB or OAGB combined with hiatoplasty carries a higher risk of ITM and therefore also gastro-esophageal reflux disease (GERD).

      Setting

      University hospital

      Methods

      Fifty patients (group 1: 25x primary OAGB; group 2: 25x primary OAGB with hiatoplasty) were included in this study. History of weight, GERD, and quality of life were recorded in patient interviews and pouch volume and ITM were evaluated using 3D-CT volumetry

      Results

      There were no differences in terms of patient characteristics, history of weight, pouch volume or quality of life between both groups. ITM was found in group 1 in 60% (n=15) and group 2 in 76% (n=19) of all patients (p=0.152). The ITM mean length was significantly lower in group 1 with 0.9 ±1.1cm than in group 2 with 1.8 ±1.2cm (p=0.007). Regarding GERD, there was no difference between both groups, nevertheless, significantly more patients with ITM (38.2%; n=13) were suffering from GERD compared to patients without ITM (6.3%; n=1).

      Conclusion

      In primary OAGB, an additional hiatoplasty was not associated with higher rates of ITM or GERD, nevertheless the length of ITM was higher after hiatoplasty. If ITM occurs, patients have a risk developing GERD.

      Key words

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