Ribieras et al. [
[1]
] have made an important contribution to the bariatric literature by evaluating the
sensitivity and specificity of preoperative symptoms and upper gastrointestinal series
(UGI) findings in comparison with intraoperative hiatal hernia diagnosis in patients
undergoing laparoscopic sleeve gastrectomy (LSG). To do so, the authors enrolled 100
patients prospectively as part of a randomized controlled trial and assessed the Gastroesophageal
Reflux Disease Questionnaire (GerdQ), Brief Esophageal Dysphagia Questionnaire (BEDQ),
and UGI before LSG. Among 93 included patients, preoperative UGI was detected in 26
patients (28%) with hiatal hernia, while 35 patients were found to have hiatal hernia
during the intraoperative anterior inspection of the crura. The sensitivity and specificity
of UGI compared with the conservative approach, which excluded 29 patients with posterior
inspection, were 35.3% and 76.3%, respectively, with an overall accuracy of 61.3%
for diagnosing hiatal hernia. GerdQ and BEDQ did not correlate to intraoperative identification
of hiatal hernia. Thus, the authors concluded that the sensitivity based on the proposed
preoperative diagnostic approaches is inadequate to “rule out” hiatal hernia prior
to LSG despite the negative tests.Ribieras AJ, Monzon Canales EJ, Manzur-Pineda K, Cuesta M, Kutlu O, De La Cruz-Munoz N. Comparison of upper gastrointestinal series and symptom questionnaires with intraoperative diagnosis of hiatal hernia during sleeve gastrectomy. Surg Obes Relat Dis. 2023. doi:10.1016/j.soard.2022.12.040.
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References
Ribieras AJ, Monzon Canales EJ, Manzur-Pineda K, Cuesta M, Kutlu O, De La Cruz-Munoz N. Comparison of upper gastrointestinal series and symptom questionnaires with intraoperative diagnosis of hiatal hernia during sleeve gastrectomy. Surg Obes Relat Dis. 2023. doi:10.1016/j.soard.2022.12.040.
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- Preoperative versus intraoperative diagnosis of hiatal hernia in bariatric population.Surg Obes Relat Dis. 2019; 15: 1949-1955
- ASMBS position statement on the rationale for performance of upper gastrointestinal endoscopy before and after metabolic and bariatric surgery.Surg Obes Relat Dis. 2021; 17: 837-847
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Publication history
Published online: February 11, 2023
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© 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
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